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Reshef A, Buttgereit T, Betschel SD, Caballero T, Farkas H, Grumach AS, Hide M, Jindal AK, Longhurst H, Peter J, Riedl MA, Zhi Y, Aberer W, Abuzakouk M, Al Farsi T, Al Sukaiti N, Al-Ahmad M, Altrichter S, Aygören-Pürsün E, Baeza ML, Bara NA, Bauer A, Bernstein JA, Boccon-Gibod I, Bonnekoh H, Bouillet L, Brzoza Z, Bygum A, Calderon O, de Albuquerque Campos R, Campos Romero FH, Cancian M, Chong-Neto HJ, Christoff G, Cimbollek S, Cohn DM, Craig T, Danilycheva I, Darlenski R, Du-Thanh A, Ensina LF, Fomina D, Fonacier L, Fukunaga A, Gelincik A, Giavina-Bianchi P, Godse K, Gompels M, Goncalo M, Gotua M, Guidos-Fogelbach G, Guilarte M, Kasperska-Zajac A, Katelaris CH, Kinaciyan T, Kolkhir P, Kulthanan K, Kurowski M, Latysheva E, Lauerma A, Launay D, Lleonhart R, Lumry W, Malbran A, Ali RM, Nasr I, Nieto-Martinez S, Parisi C, Pawankar R, Piñero-Saavedra M, Popov TA, Porebski G, Prieto Garcia A, Pyatilova P, Rudenko M, Sekerel BE, Serpa FS, Sheikh F, Siebenhaar F, Soria A, Staevska M, Staubach P, Stobiecki M, Thomsen SF, Triggiani M, Valerieva A, Valle S, Van Dinh N, Vera Ayala CE, Zalewska-Janowska A, Zanichelli A, Magerl M, Maurer M. The Definition, Acronyms, Nomenclature, and Classification of Angioedema: AAAAI, ACAAI, ACARE, and APAACI DANCE Consensus. J Allergy Clin Immunol 2024:S0091-6749(24)00407-X. [PMID: 38670233 DOI: 10.1016/j.jaci.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, occurs only once or be recurrent, with or without wheals, due to mast cell mediators, bradykinin or other mechanisms. Currently, different taxonomic systems are used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize treatments of AE patients. OBJECTIVE To develop a consensus on the definition, acronyms, nomenclature, and classification of angioedema (DANCE). METHODS The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific, medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022). RESULTS The DANCE initiative resulted in an international consensus on the definition, classification and terminology of AE. The new consensus classification features five types and endotypes of AE and a harmonized vocabulary of abbreviations and acronyms. CONCLUSION The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic workup and treatment of AE. DANCE does not replace current clinical guidelines and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by a physician using sound clinical judgment. We anticipate that the new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care.
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Affiliation(s)
- Avner Reshef
- Angioedema Research Center, Barzilai University Medical Center, Ashkelon, Israel.
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Stephen D Betschel
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Caballero
- Department of Allergy, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ - Group 44), Biomedical Research Network on Rare Diseases (CIBERER U754), Madrid, Spain; NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Anete S Grumach
- Clinical Immunology, University Center Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Michihiro Hide
- Department of Dermatology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ankur K Jindal
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hilary Longhurst
- Department of Medicine, University of Auckland and Department of Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Marc A Riedl
- Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Mohamed Abuzakouk
- Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Tariq Al Farsi
- Department of Pediatric allergy and clinical immunology, The Royal Hospital, Muscat, Oman
| | - Nashat Al Sukaiti
- Department of Pediatric allergy and clinical immunology, The Royal Hospital, Muscat, Oman
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University
| | - Sabine Altrichter
- Klinik für Dermatologie und Venerologie, Kepler Uniklinikum, Linz, Austria
| | - Emel Aygören-Pürsün
- Department of Pediatrics, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Maria Luisa Baeza
- Allergy Department, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases-U761, Institute for Health Research, Gregorio Marañón
| | - Noemi Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Centrul Clinic Mediquest, Sangeorgiu de Mures, Romania
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, OH, USA
| | | | - Hanna Bonnekoh
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Laurence Bouillet
- National Reference Center of Angioedema CREAK, Grenoble, France; Internal medicine department, Grenoble university hospital, France
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Freya Helena Campos Romero
- Department of Allergy and Clinical Immunology, Hospital Central Sur Alta Especialidad, Mexico City, Mexico City, Mexico
| | - Mauro Cancian
- Departmental Unit of Allergology, University Hospital of Padua, Padua, Italy
| | - Herberto Jose Chong-Neto
- Serviço de Alergia e Imunologia, Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - George Christoff
- Excelsior Medical Centre, Sofia, Bulgaria; Medical University - Sofia, Bulgaria
| | | | - Danny M Cohn
- Amsterdam UMC, department of Vascular Medicine, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Timothy Craig
- Department of Pediatrics, Pennsylvania State University, Hershey, Pennsylvania, USA
| | | | - Razvigor Darlenski
- Department of dermatovenereology, Trakia University-Stara Zagora, Bulgaria
| | - Aurélie Du-Thanh
- ACARE, Département de dermatologie, Centre Hospitalier Universitaire de Montpellier; Montpellier, France
| | | | - Daria Fomina
- Moscow City Research and Practical Center of Allergoloy and Immunology, Clinical Hospital No 52, Moscow Healthcare Department, Moscow, Russia
| | - Luz Fonacier
- New York University-Long Island School of Medicine, Mineola, New York, USA, Past President ACAAI
| | - Atsushi Fukunaga
- Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Türkiye
| | - Pedro Giavina-Bianchi
- Division of Clinical lmmunology and Allergy, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Kiran Godse
- Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Mark Gompels
- ACARE, Department of Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Margarida Goncalo
- Department of Dermatology, Coimbra Hospital and University Center, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maia Gotua
- Center of Allergy and Immunology, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia
| | | | - Mar Guilarte
- Allergy Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Barcelona, Spain
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria and Angioedema and Department of Clinical Allergology and Urticaria, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Pavel Kolkhir
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, Poland
| | - Elena Latysheva
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - Antti Lauerma
- Department of Dermatology, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des angioedemes à kinine (CREAK), U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Ramon Lleonhart
- Allergology Department, Hospital Universitari Bellvitge, IDIBILL Research Institute. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alejandro Malbran
- Unidad de alergia, asma e inmunología clínica, Buenos Aires, Argentina
| | - Ramzy Mohammed Ali
- Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Iman Nasr
- Immunology and Allergy department, The Royal Hospital, Muscat, Oman
| | - Sandra Nieto-Martinez
- Unidad de Genética de la Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico. Mexican Hereditary Angioedema Association. Latin American Hereditary Angioedema Association
| | - Claudio Parisi
- Pediatric and Adult Allergy Sections of the Italian Hospital of Buenos Aires
| | | | | | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicia Prieto Garcia
- Department of Allergy, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Polina Pyatilova
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | | | | | - Faradiba Sarquis Serpa
- Angioedema and Urticaria Reference Center, Hospital Santa Casa de Misericórdia de Vitória, Vitória, Espirito Santo, Brazil
| | | | - Frank Siebenhaar
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Angèle Soria
- Médecine Sorbonne Université, Service de Dermatologie et Allergologie, hôpital Tenon, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France
| | - Maria Staevska
- Department of Allergology, Medical University of Sofia, Clinic of Allergology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Petra Staubach
- ACARE, Department of Dermatology, University Medical Center Mainz, Germany
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Massimo Triggiani
- Division of Allergy and Clinical Immunology University of Salerno, Salerno, Italy
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia, Clinic of Allergology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | | | - Nguyen Van Dinh
- Respiratory - Allergy and Clinical Immunology Unit, Department of General Internal Medicine, Vinmec Healthcare System, Hanoi, Vietnam
| | - Carolina Elisa Vera Ayala
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Anna Zalewska-Janowska
- Department of Psychodermatology, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, Poland
| | - Andrea Zanichelli
- Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy; Operative Unit of Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine, and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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Petersen RS, Fijen LM, Apfelbacher C, Magerl M, Weller K, Aberer W, Adatia A, Audhya P, Bara NA, Betschel S, Boccon-Gibod I, Bouillet L, Brodszki N, Busse PJ, Buttgereit T, Bygum A, Cancian M, Craig T, Csuka D, Farkas H, Fomina D, Gil-Serrano J, Gompels M, Fogelbach GG, Guilarte M, Hide M, Kiani-Alikhan S, Kinaciyan T, Lenten A, Lleonart R, Longhurst H, Lumry WR, Malbran A, Malinauskiene L, Matta Campos JJ, Mendivil J, Nieto-Martinez SA, Peter JG, Porebski G, Reshef A, Riedl M, Valerieva A, Waserman S, Maurer M, Cohn DM. A core outcome set for efficacy of acute treatment of hereditary angioedema. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00391-X. [PMID: 38609017 DOI: 10.1016/j.jaip.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Clinical trials investigating drugs for acute treatment of hereditary angioedema attacks have assessed many different outcomes. This heterogeneity limits comparability of trial results and may lead to selective outcome reporting bias and a high burden on trial participants. OBJECTIVE To achieve consensus on a Core Outcome Set comprising key outcomes that should ideally be utilized in all clinical efficacy trials involving acute treatment of hereditary angioedema attacks. METHODS A Delphi consensus study was conducted involving all relevant parties: hereditary angioedema patients, hereditary angioedema expert clinicians and clinical researchers, pharmaceutical companies, and regulatory bodies. Two internet-based survey rounds were conducted. In round 1, panelists indicated the importance of individual outcomes used in clinical trials on a 9-point Likert scale. Based on these results, a core outcome set was developed and voted on by panelists in round 2. RESULTS Fifty-eight worldwide panelists completed both rounds. The first round demonstrated high importance scores and substantial agreement among the panelists. In the second round, a consensus of ≥90% was achieved on a core outcome set consisting of five key outcomes: change in overall symptom severity at one predetermined time point between 15 minutes and 4 hours after treatment, time to end of progression of all symptoms, need for rescue medication during the entire attack, impairment of daily activities, and treatment satisfaction. CONCLUSION This international study obtained a high level of consensus on a core outcome set for acute treatment of hereditary angioedema attacks consisting of five key outcomes.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Karsten Weller
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Adil Adatia
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Audhya
- KalVista Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Noémi-Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center, Sangeorgiu de Mures, Romania
| | - Stephen Betschel
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Isabelle Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), CHU Grenoble Alpes, France
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), CHU Grenoble Alpes, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - Nicholas Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital, Lund, Sweden
| | - Paula J Busse
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Anette Bygum
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Timothy Craig
- Allergy, Asthma and Immunology, Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence (ACARE), Semmelweis University, Budapest, Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence (ACARE), Semmelweis University, Budapest, Hungary
| | - Daria Fomina
- Urticaria Center of Reference and Excellence (UCARE), Moscow Research and Clinical Center of Allergy and Immunology, Clinical City Hospital 52 , Russia; Sechenov University, Moscow, Russia; Astana Medical University, Kazakhstan
| | - Johana Gil-Serrano
- Allergy Section Department, Department of Internal Medicine, Hospital Universitari Vall d' Hebron, Barcelona, Spain; Allergy Research Unit, Allergy Department, Institut de Recerca Vall d', Hebron (VHIR). Universitat Autònoma de Barcelona, Spain
| | - Mark Gompels
- Clinical Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Mar Guilarte
- Allergy Section Department, Department of Internal Medicine, Hospital Universitari Vall d' Hebron, Barcelona, Spain; Allergy Research Unit, Allergy Department, Institut de Recerca Vall d', Hebron (VHIR). Universitat Autònoma de Barcelona, Spain
| | - Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Ramon Lleonart
- Allergology Department, Hospital Universitari de Bellvitge, Institut de Recerca IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain
| | - Hilary Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland, Auckland, New Zealand
| | - William R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center, Dallas, TX, United States
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunologia Clinica, Buenos Aires, Argentina
| | - Laura Malinauskiene
- Vilnius University, Medical Faculty, Clinic of Chest Diseases, Immunology and Allergology, VUH Santaros Klinikos, Department of Pulmonology and Allergology, Vilnius, Lithuania
| | | | - Joan Mendivil
- Head Evidence & Outcomes Research, Pharvaris GmbH, Switzerland
| | | | - Jonathan G Peter
- Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town & Allergy and Immunology Unit, University of Cape Town Lung Institute
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Avner Reshef
- Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia & ACARE Bulgaria (University Hospital "Alexandrovska"), Sofia, Bulgaria
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Marcus Maurer
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Riedl MA, Bordone L, Revenko A, Newman KB, Cohn DM. Clinical Progress in Hepatic Targeting for Novel Prophylactic Therapies in Hereditary Angioedema. J Allergy Clin Immunol Pract 2024; 12:911-918. [PMID: 38142864 DOI: 10.1016/j.jaip.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023]
Abstract
Hereditary angioedema (HAE) is typically caused by a deficiency of the protease inhibitor C1 inhibitor (C1INH). The absence of C1INH activity on plasma kallikrein and factor XIIa leads to overproduction of the vasoactive peptide bradykinin, with resulting angioedema. As the primary site of C1INH and prekallikrein production, the liver is recognized as an important therapeutic target in HAE, leading to the development of hepatic-focused treatment strategies such as GalNAc-conjugated antisense technology and gene modification. This report reviews currently available data on hepatic-focused interventions for HAE that have advanced into human trials. Donidalorsen is an investigational GalNAc3-conjugated antisense oligonucleotide that binds to prekallikrein mRNA in the liver and reduces the expression of prekallikrein. Phase 2 data with subcutaneous donidalorsen demonstrated a significant reduction in HAE attack rate compared with placebo. Phase 3 trials are underway. ADX-324 is a GalNAc3-conjugated short-interfering RNA being investigated in HAE. BMN 331 is an investigational AAV5-based gene therapy vector that expresses wild-type human C1INH and is targeted to hepatocytes. A single intravenous dose of BMN 331 is intended to replace the defective SERPING1 gene and enable patients to produce functional C1INH. A first-in-human phase 1/2 study is ongoing with BMN 331. NTLA-2002 is an investigational in vivo clustered regularly interspaced short palindromic repeats/Cas9-based therapy designed to knock out the prekallikrein-coding KLKB1 gene in hepatocytes; a phase 1/2 study is ongoing. Findings from these and other ongoing studies are highly anticipated with the expectation of expanding the array of treatment options in HAE.
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Affiliation(s)
- Marc A Riedl
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif.
| | | | | | | | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Petersen RS, Fijen LM, Kelder JP, Cohn DM. Deucrictibant for angioedema due to acquired C1-inhibitor deficiency: A randomized-controlled trial. J Allergy Clin Immunol 2024:S0091-6749(24)00271-9. [PMID: 38494092 DOI: 10.1016/j.jaci.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Angioedema due to acquired C1-inhibitor deficiency is a very rare but serious disease, with an estimated prevalence of 1 per 500,000 persons. There are no approved therapies to treat or prevent angioedema swelling in patients with this condition. Deucrictibant is a specific, orally bioavailable, competitive antagonist of the bradykinin B2 receptor currently under investigation for hereditary angioedema. OBJECTIVE Our aim was to assess the efficacy and safety of deucrictibant as acute and prophylactic treatment for angioedema due to acquired C1-inhibitor deficiency. METHODS A 2-part, randomized, double-blind, placebo-controlled crossover study was conducted. In Part 1, 4 consecutive angioedema attacks were treated with 3 doses of deucrictibant (10 mg, 20 mg, and 30 mg) or placebo. In Part 2, deucricibant, 20 mg, or placebo was administered twice daily for 2 treatment periods of 8 weeks. RESULTS Three patients were enrolled; of those 3 patients, 1 completed both study parts and 2 completed only Part 2. In Part 1, a reduction in attack severity was observed in the 3 attacks treated with deucrictibant as opposed to an increase in severity of the attack treated with placebo. In Part 2, the individual mean monthly attack rates were 2.0, 0.6, and 1.0 during the placebo period and 0.0 across all patients during treatment with deucrictibant. There were no severe adverse events and 1 self-limiting treatment-emergent adverse event (abdominal pain). CONCLUSIONS Deucrictibant has the potential to effectively and safely treat and prevent angioedema attacks due to acquired C1-inhibitor deficiency.
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Affiliation(s)
- Remy S Petersen
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Lauré M Fijen
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes P Kelder
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Danny M Cohn
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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Petersen RS, Bordone L, Riedl MA, Tachdjian R, Craig TJ, Lumry WR, Manning ME, Bernstein JA, Raasch J, Zuraw BL, Deng Y, Newman KB, Alexander VJ, Lui C, Schneider E, Cohn DM. A phase 2 open-label extension study of prekallikrein inhibition with donidalorsen for hereditary angioedema. Allergy 2024; 79:724-734. [PMID: 38009241 DOI: 10.1111/all.15948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a potentially fatal disease characterized by unpredictable, recurrent, often disabling swelling attacks. In a randomized phase 2 study, donidalorsen reduced HAE attack frequency and improved patient quality-of-life (ISIS721744-CS2, NCT04030598). We report the 2-year interim analysis of the phase 2 open-label extension (OLE) study (ISIS 721744-CS3, NCT04307381). METHODS In the OLE, the on-treatment study period consisted of fixed (weeks 1-13, donidalorsen 80 mg subcutaneously every 4 weeks [Q4W]) and flexible (weeks 17-105, donidalorsen 80 mg Q4W, 80 mg every 8 weeks [Q8W], or 100 mg Q4W) dosing periods. The primary outcome was incidence and severity of treatment-emergent adverse events (TEAEs). The secondary outcomes included efficacy, pharmacodynamic, and quality-of-life assessments. RESULTS Seventeen patients continued in the OLE study. No serious TEAEs or TEAEs leading to treatment discontinuation were reported. Mean monthly HAE attack rate was 96% lower than the study run-in baseline rate (mean, 0.06/month; 95% confidence interval [CI], 0.02-0.10; median, 0.04 on-treatment vs. mean, 2.70/month; 95% CI, 1.94-3.46; median, 2.29 at baseline). Mean monthly attack rate for Q8W dosing (n = 8) was 0.29 (range, 0.0-1.7; 95% CI, -0.21 to 0.79; median, 0.00). Mean plasma prekallikrein and D-dimer concentrations decreased, and Angioedema Quality of Life Questionnaire total score improved from baseline to week 105 with donidalorsen. CONCLUSION The 2-year interim results of this phase 2 OLE study of donidalorsen in patients with HAE demonstrated no new safety signals; donidalorsen was well tolerated. There was durable efficacy with a 96% reduction in HAE attacks.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Bordone
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Marc A Riedl
- University of California San Diego, La Jolla, California, USA
| | - Raffi Tachdjian
- Department of Pediatrics, University of California, Los Angeles, California, USA
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
- Vinmec International Hospital, Times City, Hanoi, Vietnam
| | - William R Lumry
- Allergy and Asthma Research Associates Research Center, Dallas, Texas, USA
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, and Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Jason Raasch
- Midwest Immunology Clinic, Plymouth, Minnesota, USA
| | - Bruce L Zuraw
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Yiwen Deng
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | | | - Cindy Lui
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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6
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Longhurst HJ, Lindsay K, Petersen RS, Fijen LM, Gurugama P, Maag D, Butler JS, Shah MY, Golden A, Xu Y, Boiselle C, Vogel JD, Abdelhady AM, Maitland ML, McKee MD, Seitzer J, Han BW, Soukamneuth S, Leonard J, Sepp-Lorenzino L, Clark ED, Lebwohl D, Cohn DM. CRISPR-Cas9 In Vivo Gene Editing of KLKB1 for Hereditary Angioedema. N Engl J Med 2024; 390:432-441. [PMID: 38294975 DOI: 10.1056/nejmoa2309149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Hereditary angioedema is a rare genetic disease that leads to severe and unpredictable swelling attacks. NTLA-2002 is an in vivo gene-editing therapy based on clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9. NTLA-2002 targets the gene encoding kallikrein B1 (KLKB1), with the goal of lifelong control of angioedema attacks after a single dose. METHODS In this phase 1 dose-escalation portion of a combined phase 1-2 trial of NTLA-2002 in adults with hereditary angioedema, we administered NTLA-2002 at a single dose of 25 mg, 50 mg, or 75 mg. The primary end points were the safety and side-effect profile of NTLA-2002 therapy. Secondary and exploratory end points included pharmacokinetics, pharmacodynamics, and clinical efficacy determined on the basis of investigator-confirmed angioedema attacks. RESULTS Three patients received 25 mg of NTLA-2002, four received 50 mg, and three received 75 mg. At all dose levels, the most common adverse events were infusion-related reactions and fatigue. No dose-limiting toxic effects, serious adverse events, grade 3 or higher adverse events, or clinically important laboratory findings were observed after the administration of NTLA-2002. Dose-dependent reductions in the total plasma kallikrein protein level were observed between baseline and the latest assessment, with a mean percentage change of -67% in the 25-mg group, -84% in the 50-mg group, and -95% in the 75-mg group. The mean percentage change in the number of angioedema attacks per month between baseline and weeks 1 through 16 (primary observation period) was -91% in the 25-mg group, -97% in the 50-mg group, and -80% in the 75-mg group. Among all the patients, the mean percentage change in the number of angioedema attacks per month from baseline through the latest assessment was -95%. CONCLUSIONS In this small study, a single dose of NTLA-2002 led to robust, dose-dependent, and durable reductions in total plasma kallikrein levels, and no severe adverse events were observed. In exploratory analyses, reductions in the number of angioedema attacks per month were observed at all dose levels. (Funded by Intellia Therapeutics; ClinicalTrials.gov number, NCT05120830.).
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Affiliation(s)
- Hilary J Longhurst
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Karen Lindsay
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Remy S Petersen
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Lauré M Fijen
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Padmalal Gurugama
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - David Maag
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - James S Butler
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Mrinal Y Shah
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Adele Golden
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Yuanxin Xu
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Carri Boiselle
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Joseph D Vogel
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Ahmed M Abdelhady
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Michael L Maitland
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Mark D McKee
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Jessica Seitzer
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Bo W Han
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Samantha Soukamneuth
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - John Leonard
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Laura Sepp-Lorenzino
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Eliana D Clark
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - David Lebwohl
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Danny M Cohn
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
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7
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Petersen RS, Fijen LM, Cohn DM. Efficacy outcomes in trials with prophylactic hereditary angioedema therapy: A systematic review. Allergy 2023. [PMID: 38009479 DOI: 10.1111/all.15962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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8
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Fijen LM, Petersen RS, Cohn DM. [Facial swelling due to angioedema: often mast cell mediated, but not always]. Ned Tijdschr Geneeskd 2023; 167:D7610. [PMID: 37850628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Most cases of angioedema are mast cell mediated. We present three patients with angioedema, who were admitted to our emergency room or outpatient clinic. One of them did have mast cell mediated angioedema, despite insufficient response to initial antihistamine treatment. The other patients had more rare cases of angioedema, i.e. hereditary angioedema with C1-inhibitor deficiency and angiotensin converting enzyme inhibitor associated angioedema. We discuss similarities and differences in symptoms, diagnosis and treatment between these causes of angioedema. We recommend keeping the differential diagnosis of angioedema in mind when a patient with angioedema is presented, including rarer pathophysiological explanations.
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Affiliation(s)
- Lauré M Fijen
- Amsterdam UMC, locatie AMC, Amsterdam. Afd. Interne Geneeskunde
- Contact: Lauré M. Fijen
| | - Remy S Petersen
- Amsterdam UMC, locatie AMC, Amsterdam. Afd. Vasculaire Geneeskunde
| | - Danny M Cohn
- Amsterdam UMC, locatie AMC, Amsterdam. Afd. Vasculaire Geneeskunde
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Cupido AJ, Petersen RS, Schmidt AF, Levi M, Cohn DM, Fijen LM. "C1-inhibitor levels and venous thromboembolism: results from a Mendelian randomization study": reply. J Thromb Haemost 2023; 21:2988-2990. [PMID: 37739596 DOI: 10.1016/j.jtha.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Arjen J Cupido
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Amand F Schmidt
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK; Health Data Research UK and Institute of Health Informatics, University College London, London, UK; UCL British Heart Foundation Research Accelerator, London, UK
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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10
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Cupido AJ, Petersen RS, Schmidt AF, Levi M, Cohn DM, Fijen LM. C1-inhibitor levels and venous thromboembolism: results from a Mendelian randomization study. J Thromb Haemost 2023; 21:2623-2625. [PMID: 37230417 DOI: 10.1016/j.jtha.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Arjen J Cupido
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Amand F Schmidt
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK; Health Data Research UK and Institute of Health Informatics, University College London, London, UK; University College London, British Heart Foundation Research Accelerator Center, London, UK
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Cohn DM, Aygören‐Pürsün E, Bernstein JA, Farkas H, Lumry WR, Maurer M, Zanichelli A, Iverson M, Hao J, Smith MD, Yea CM, Audhya PK, Riedl MA. Evaluation of patient-reported outcome measures for on-demand treatment of hereditary angioedema attacks and design of KONFIDENT, a phase 3 trial of sebetralstat. Clin Transl Allergy 2023; 13:e12288. [PMID: 37746795 PMCID: PMC10476273 DOI: 10.1002/clt2.12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/02/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) with C1-inhibitor deficiency (HAE-C1-INH) is characterized by recurrent, debilitating episodes of swelling. Sebetralstat, an investigational oral plasma kallikrein inhibitor, demonstrated promising efficacy for on-demand treatment of HAE-C1-INH in a phase 2 trial. We describe the multipronged approach informing the design of KONFIDENT, a phase 3 randomized, placebo-controlled, three-way crossover trial evaluating the efficacy and safety of sebetralstat in patients aged ≥12 years with HAE-C1-INH. METHODS To determine an optimal endpoint to measure the beginning of symptom relief in KONFIDENT, we engaged patients with HAE on clinical outcome measures and subsequently conducted analyses of phase 2 outcomes. Sample size was determined via a simulation-based approach using phase 2 data. RESULTS Patient interviews revealed a strong preference (71%) for the Patient Global Impression of Change (PGI-C) over other measures and indicated a rating of "A Little Better" as a clinically meaningful milestone. In phase 2, a rating of "A Little Better" demonstrated agreement with attack severity improvement and resolution on the Patient Global Impression of Severity and had better sensitivity than "Better." Simulations indicated that 84 patients completing treatment would ensure at least 90% power for assessing the primary endpoint of time to beginning of symptom relief defined as a PGI-C rating of at least "A Little Better" for two time points in a row. CONCLUSIONS Patient feedback and phase 2 data support PGI-C as the primary outcome measure in the phase 3 KONFIDENT trial evaluating sebetralstat, which has the potential to be the first oral on-demand treatment for HAE-C1-INH attacks.
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Affiliation(s)
- Danny M. Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Emel Aygören‐Pürsün
- Department for Children and AdolescentsUniversity Hospital FrankfurtFrankfurtGermany
| | - Jonathan A. Bernstein
- Division of Rheumatology, Allergy and ImmunologyDepartment of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and ExcellenceDepartment of Internal Medicine and HaematologySemmelweis UniversityBudapestHungary
| | | | - Marcus Maurer
- Institute of AllergologyCharité ‐ Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | - Andrea Zanichelli
- Operative Unit of MedicineAngioedema CenterIRCCS Policlinico San DonatoMilanItaly
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | | | - James Hao
- KalVista PharmaceuticalsCambridgeMassachusettsUSA
| | | | | | | | - Marc A. Riedl
- Division of Rheumatology, Allergy & ImmunologyUniversity of California San DiegoSan DiegoCaliforniaUSA
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12
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Fijen LM, Klein PCG, Cohn DM, Kanters TA. The Disease Burden and Societal Costs of Hereditary Angioedema. J Allergy Clin Immunol Pract 2023; 11:2468-2475.e2. [PMID: 36990433 DOI: 10.1016/j.jaip.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/12/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND According to the current treatment guidelines, the goals of treatment of patients with hereditary angioedema (HAE) are to achieve total control of the disease and to normalize patients' lives. OBJECTIVE This study aims to establish the entire burden of HAE comprising disease control, treatment satisfaction, reductions in quality of life, and societal costs. METHODS Adult patients with HAE under treatment at the Dutch national center of reference completed a cross-sectional survey in 2021. The survey consisted of different questionnaires: angioedema-specific questionnaires (4-week Angioedema Activity Score and Angioedema Control Test), quality of life questionnaires (Angioedema Quality of Life [AE-QoL] questionnaire and EQ-5D-5L), the Treatment Satisfaction Questionnaire for Medication (TSQM), and societal costs questionnaires (iMTA Medical Consumption Questionnaire and iMTA Productivity Cost Questionnaire). RESULTS The response rate was 78% (69 of 88). The entire sample had a mean Angioedema Activity Score of 16.61, and 36% of participants had poorly controlled disease as expressed by the Angioedema Control Test. The mean quality of life in the entire sample was 30.99 as expressed by the AE-QoL and 0.873 as expressed by the EQ-5D-5L utility value. Utilities dropped by 0.320 points during an angioedema attack. TSQM scores ranged from 66.67 to 75.00 across its 4 domains. On average, total costs per year incurred €22,764, predominantly existing of HAE-medication costs. Total costs showed substantial variation between patients. CONCLUSIONS This study describes the entire burden of HAE among Dutch patients comprising disease control, quality of life, treatment satisfaction, and societal costs. These results can inform cost-effectiveness analyses that can aid reimbursement decisions for HAE treatments.
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Affiliation(s)
- Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Philip C G Klein
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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13
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Betschel SD, Banerji A, Busse PJ, Cohn DM, Magerl M. Hereditary Angioedema: A Review of the Current and Evolving Treatment Landscape. J Allergy Clin Immunol Pract 2023; 11:2315-2325. [PMID: 37116793 DOI: 10.1016/j.jaip.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023]
Abstract
Hereditary angioedema (HAE) is a rare disease characterized by sudden and often unprovoked episodes of swelling that can be potentially life-threatening when it involves the upper airway. The treatment options for both acute episodes of HAE and LTP, used to minimize the frequency and severity of angioedema attacks, were limited historically to very few options, had considerable side effects, and/or had considerable burden of treatment. Fortunately, through the elucidation of the pathophysiology of HAE, the development of newer targeted therapies has been possible both for acute therapy and long-term prophylaxis and even more are on the horizon. Because of the rapid development of these therapies, it can be challenging for clinicians to keep abreast of newer and developing treatments for HAE. This review article will outline the current and potential future treatments for HAE. It will also highlight important considerations when treating special HAE patient populations including women and pediatric patients.
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Affiliation(s)
- Stephen D Betschel
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Aleena Banerji
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Mass.
| | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Danny M Cohn
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
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14
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Aygören-Pürsün E, Zanichelli A, Cohn DM, Cancian M, Hakl R, Kinaciyan T, Magerl M, Martinez-Saguer I, Stobiecki M, Farkas H, Kiani-Alikhan S, Grivcheva-Panovska V, Bernstein JA, Li HH, Longhurst HJ, Audhya PK, Smith MD, Yea CM, Maetzel A, Lee DK, Feener EP, Gower R, Lumry WR, Banerji A, Riedl MA, Maurer M. An investigational oral plasma kallikrein inhibitor for on-demand treatment of hereditary angioedema: a two-part, randomised, double-blind, placebo-controlled, crossover phase 2 trial. Lancet 2023; 401:458-469. [PMID: 36774155 DOI: 10.1016/s0140-6736(22)02406-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Guidelines recommend effective on-demand therapy for all individuals with hereditary angioedema. We aimed to assess the novel oral plasma kallikrein inhibitor, sebetralstat, which is in development, for on-demand treatment of hereditary angioedema attacks. METHODS In this two-part phase 2 trial, individuals with type 1 or 2 hereditary angioedema aged 18 years or older were recruited from 25 sites, consisting of specialty outpatient centres, across nine countries in Europe and the USA. Individuals were eligible if they had experienced at least three hereditary angioedema attacks in the past 93 days, were not on prophylactic therapy, and had access to and the ability to self-administer conventional attack treatment. In part 1 of the trial, participants were given a single 600 mg open-label oral dose of sebetralstat to assess safety, pharmacokinetics, and pharmacodynamics of the dose. Part 2 was a randomised, double-blind, placebo-controlled, two-sequence, two-period (2 × 2) crossover trial; participants were randomly assigned (1:1) to either sequence 1, in which they were given a single dose of 600 mg of sebetralstat to treat the first eligible attack and a second dose of placebo to treat the second eligible attack, or sequence 2, in which they were given placebo to treat the first eligible attack and then 600 mg of sebetralstat to treat the second eligible attack. Participants and investigators were masked to treatment assignment. The primary endpoint was time to use of conventional attack treatment within 12 h of study drug administration, which was assessed in all participants who were randomly assigned to treatment and who received study drug for two attacks during part 2 of the study. Safety was assessed in all participants who received at least one dose of study drug, starting in part 1. This study is registered with ClinicalTrials.gov, NCT04208412, and is completed. FINDINGS Between July 2, 2019, and Dec 8, 2020, 84 individuals were screened and 68 were enrolled in part 1 and received sebetralstat (mean age 38·3 years [SD 13·2], 37 [54%] were female, 31 [46%] were male, 68 [100%] were White). 42 (62%) of 68 participants completed pharmacokinetic assessments. Sebetralstat was rapidly absorbed, with a geometric mean plasma concentration of 501 ng/mL at 15 min. In a subset of participants (n=6), plasma samples obtained from 15 min to 4 h after study drug administration had near-complete protection from ex vivo stimulated generation of plasma kallikrein and cleavage of high-molecular-weight kininogen. In part 2, all 68 participants were randomly assigned to sequence 1 (n=34) or sequence 2 (n=34). 53 (78%) of 68 participants treated two attacks (25 [74%] in the sequence 1 group and 28 [82%] in the sequence 2 group). Time to use of conventional treatment within 12 h of study drug administration was significantly longer with sebetralstat versus placebo (at quartile 1: >12 h [95% CI 9·6 to >12] vs 8·0 h [3·8 to >12]; p=0·0010). There were no serious adverse events or adverse event-related discontinuations. INTERPRETATION Oral administration of sebetralstat was well tolerated and led to rapid suppression of plasma kallikrein activity, resulting in increased time to use of conventional attack treatment and faster symptom relief versus placebo. Based on these results, a phase 3 trial to evaluate the efficacy and safety of two dose levels of sebetralstat in adolescent and adult participants with hereditary angioedema has been initiated (NCT05259917). FUNDING KalVista Pharmaceuticals.
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Affiliation(s)
- Emel Aygören-Pürsün
- Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt, Germany
| | - Andrea Zanichelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Operative Unit of Medicine, IRCCS Policlinico San Donato, Milan, Italy
| | - Danny M Cohn
- Amsterdam UMC, Department of Vascular Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Roman Hakl
- Department of Clinical Immunology and Allergology, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Markus Magerl
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | | | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Sorena Kiani-Alikhan
- Barts Health NHS Trust, Department of Immunology, GA(2)LEN/HAEi Angioedema Centre of Reference and Excellence, London, UK
| | - Vesna Grivcheva-Panovska
- PHI University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodius, Skopje, North Macedonia
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati, OH, USA
| | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, MD, USA
| | - Hilary J Longhurst
- Department of Immunology, Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | | | | | | | - Andreas Maetzel
- KalVista Pharmaceuticals, Cambridge, MA, USA; Institute of Health Policy, Management & Evaluation, University of Toronto, ON, Canada
| | | | | | | | | | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, USA
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris C, Kiani-Alikhan S, Lei WT, Lockey R, Longhurst H, Lumry WR, MacGinnitie A, Malbran A, Saguer IM, Matta JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. [Not Available]. ARERUGI = [ALLERGY] 2023; 72:237-272. [PMID: 37225467 DOI: 10.15036/arerugi.72.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- M Maurer
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - M Magerl
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | | | - W Aberer
- Department of Dermatology, Medical University of Graz
| | - I J Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia
| | - E Aygören-Pürsün
- Center for Children and Adolescents, University Hospital Frankfurt
| | - A Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital
| | - N A Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center
| | - I Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | - K Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University
| | - L Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | | | - N Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital
| | - P J Busse
- Icahn School of Medicine at Mount Sinai
| | - A Bygum
- Clinical Institute, University of Southern Denmark
- Department of Clinical Genetics, Odense University Hospital
| | - T Caballero
- Allergy Department, Hospital Universitario La Paz
| | - M Cancian
- Department of Systems Medicine, University Hospital of Padua
| | | | - D M Cohn
- Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam
| | - D Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - H Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - M Gompels
- Clinical Immunology, North Bristol NHS Trust
| | - R Gower
- Marycliff Clinical Research, Principle Research Solutions
| | - A S Grumach
- Clinical Immunology, Centro Universitario FMABC
| | | | - M Hide
- Department of Dermatology, Hiroshima Citizens Hospital
- Department of Dermatology, Hiroshima University
| | - H R Kang
- Department of Internal Medicine, Seoul National University College of Medicine
| | - A P Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology, Medical University of South Carolina
| | - C Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University
| | | | - W T Lei
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Mackay Memorial Hospital
| | - R Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida
| | - H Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland
| | - W R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center
| | - A MacGinnitie
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School
| | - A Malbran
- Unidad de Alergia, Asma e Inmunología Clínica
| | - I M Saguer
- Pediatrics, Haemophilia Centre Rhine Main (HZRM)
| | - J J Matta
- H. Especialidades C.M.N.SXXI, I.M.S.S
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - D Nguyen
- Respiratory, Allergy and Clinical Immunology Unit, Internal Medicine Department, Vinmec Healthcare System, College of Health Sciences, VinUniversity
| | | | - R Pawankar
- Department of Pediatrics, Nippon Medical School
| | - J Peter
- Division of Allergy and Clinical Immunology, University of Cape Town
- Allergy and Immunology Unit, University of Cape Town Lung Institute
| | - G Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - N Prior
- Allergy, Hospital Universitario Severo Ochoa
| | - A Reshef
- Angioderma Center, Barzilai University Medical Center
| | - M Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego
| | - B Ritchie
- Departments of Medicine and Medical Oncology, University of Alberta
| | - F R Sheikh
- Section of Adult Allergy & Immunology, Department of Medicine, King Faisal Specialist Hospital & Research Centre
| | - W B Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital
| | - P J Spaeth
- Institute of Pharmacology, University of Bern
| | - M Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - E Toubi
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
| | - L A Varga
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - K Weller
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - A Zanichelli
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco-University of Milan
| | - Y Zhi
- Department of Allergy and Clinical Immunology, Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences
| | - B Zuraw
- University of California, San Diego
| | - T Craig
- Departments of Medicine and Pediatrics, Penn State University
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Petersen RS, Fijen LM, Cohn DM. "Hereditary angioedema is associated with an increased risk of venous thromboembolism": comment from Petersen et al. J Thromb Haemost 2023; 21:179. [PMID: 36695381 DOI: 10.1016/j.jtha.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Petersen RS, Fijen LM, Levi M, Cohn DM. Hereditary Angioedema: The Clinical Picture of Excessive Contact Activation. Semin Thromb Hemost 2022. [PMID: 36417927 DOI: 10.1055/s-0042-1758820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hereditary angioedema is a rare, genetic disorder characterized by painful, debilitating and potentially life-threatening angioedema attacks in subcutaneous and submucosal tissue. While usually unpredictable, attacks can be provoked by a variety of triggers including physical injury and certain medication and are often preceded by prodromal symptoms. Hereditary angioedema has a profound influence on the patients' lives. The fundamental cause of hereditary angioedema in almost all patients is a mutation in the SERPING1 gene leading to a deficiency in C1-inhibitor. Subsequently, the contact activation cascade and kallikrein-kinin pathway are insufficiently inhibited, resulting in excessive bradykinin production triggering vascular leakage. While C1-inhibitor is an important regulator of the intrinsic coagulation pathway, fibrinolytic system and complement cascade, patients do not have an increased risk of coagulopathy, autoimmune conditions or immunodeficiency disorders. Hereditary angioedema is diagnosed based on C1-inhibitor level and function. Genetic analysis is only required in rare cases where hereditary angioedema with normal C1-inhibitor is found. In recent years, new, highly specific therapies have greatly improved disease control and angioedema-related quality of life. This article reviews the clinical picture of hereditary angioedema, the underlying pathophysiology, diagnostic process and currently available as well as investigational therapeutic options.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marcel Levi
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
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Fijen LM, Petersen RS, Meijers JCM, Bordone L, Levi M, Cohn DM. The Influence of Plasma Prekallikrein Oligonucleotide Antisense Therapy on Coagulation and Fibrinolysis Assays: A Post-hoc Analysis. Thromb Haemost 2022; 122:2045-2049. [PMID: 35977698 PMCID: PMC9718591 DOI: 10.1055/a-1926-2367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Lauré M. Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Address for correspondence Lauré M. Fijen, MD Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, University of AmsterdamMeibergdreef 9, AmsterdamThe Netherlands
| | - Remy S. Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost C. M. Meijers
- Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Department of Molecular Hematology, Sanquin Research, Amsterdam, The Netherlands
| | - Laura Bordone
- Ionis Pharmaceuticals, Carlsbad, California, United States
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Danny M. Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Fijen LM, Petersen RS, Levi M, Lakeman P, Henneman L, Cohn DM. Patient perspectives on reproductive options for hereditary angioedema: A cross-sectional survey study. J Allergy Clin Immunol Pract 2022; 10:2483-2486.e1. [PMID: 35690368 DOI: 10.1016/j.jaip.2022.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Fijen LM, Riedl MA, Bordone L, Bernstein JA, Raasch J, Tachdjian R, Craig T, Lumry WR, Manning ME, Alexander VJ, Newman KB, Revenko A, Baker BF, Nanavati C, MacLeod AR, Schneider E, Cohn DM. Inhibition of Prekallikrein for Hereditary Angioedema. N Engl J Med 2022; 386:1026-1033. [PMID: 35294812 DOI: 10.1056/nejmoa2109329] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hereditary angioedema is characterized by recurrent and unpredictable swellings that are disabling and potentially fatal. Selective inhibition of plasma prekallikrein production by antisense oligonucleotide treatment (donidalorsen) may reduce the frequency of attacks and the burden of disease. METHODS In this phase 2 trial, we randomly assigned, in a 2:1 ratio, patients with hereditary angioedema with C1 inhibitor deficiency to receive four subcutaneous doses of either donidalorsen (80 mg) or placebo, with one dose administered every 4 weeks. The primary end point was the time-normalized number of investigator-confirmed angioedema attacks per month (attack rate) between week 1 (baseline) and week 17. Secondary end points included quality of life, as measured with the Angioedema Quality of Life Questionnaire (scores range from 0 to 100, with higher scores indicating worse quality of life), and safety. RESULTS A total of 20 patients were enrolled, of whom 14 were randomly assigned to receive donidalorsen and 6 to receive placebo. The mean monthly rate of investigator-confirmed angioedema attacks was 0.23 (95% confidence interval [CI], 0.08 to 0.39) among patients receiving donidalorsen and 2.21 (95% CI, 0.58 to 3.85) among patients receiving placebo (mean difference, -90%; 95% CI, -96 to -76; P<0.001). The mean change from baseline to week 17 in the Angioedema Quality of Life Questionnaire score was -26.8 points in the donidalorsen group and -6.2 points in the placebo group (mean difference, -20.7 points; 95% CI, -32.7 to -8.7). The incidence of mild-to-moderate adverse events was 71% among patients receiving donidalorsen and 83% among those receiving placebo. CONCLUSIONS Among patients with hereditary angioedema, donidalorsen treatment resulted in a significantly lower rate of angioedema attacks than placebo in this small, phase 2 trial. (Funded by Ionis Pharmaceuticals; ISIS 721744-CS2 ClinicalTrials.gov number, NCT04030598.).
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Affiliation(s)
- Lauré M Fijen
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Marc A Riedl
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Laura Bordone
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Jonathan A Bernstein
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Jason Raasch
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Raffi Tachdjian
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Timothy Craig
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - William R Lumry
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Michael E Manning
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Veronica J Alexander
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Kenneth B Newman
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Alexey Revenko
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Brenda F Baker
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Charvi Nanavati
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - A Robert MacLeod
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Eugene Schneider
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
| | - Danny M Cohn
- From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (L.M.F., D.M.C.); the Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla (M.A.R.), Ionis Pharmaceuticals, Carlsbad (L.B., V.J.A., K.B.N., A.R., B.F.B., C.N., A.R.M., E.S.), and the Division of Allergy, Immunology, and Rheumatology, University of California, Los Angeles, Los Angeles (R.T.) - all in California; the Department of Internal Medicine, Division of Immunology-Allergy Section and the Bernstein Clinical Research Center, University of Cincinnati College of Medicine, Cincinnati (J.A.B.); the Midwest Immunology Clinic, Plymouth, MN (J.R.); the Department of Medicine and Pediatrics, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Asthma and Allergy Research Associates, Dallas (W.R.L.); and Medical Research of Arizona, Scottsdale (M.E.M.)
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo AJ, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris CH, Kiani-Alikhan S, Lei WT, Lockey RF, Longhurst H, Lumry W, MacGinnitie A, Malbran A, Martinez Saguer I, Matta Campos JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema – The 2021 revision and update. World Allergy Organ J 2022; 15:100627. [PMID: 35497649 PMCID: PMC9023902 DOI: 10.1016/j.waojou.2022.100627] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/05/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022] Open
Abstract
Hereditary Angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1-inhibitor (type 1) and HAE with dysfunctional C1-inhibitor (type 2), by providing guidance on common and important clinical issues, such as: 1) How should HAE be diagnosed? 2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? 3) What are the goals of treatment? 4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast feeding women? 5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Fijen LM, Petersen RS, Cohn DM. Outcome measures in randomized controlled studies of acute therapy for hereditary angioedema: A systematic review. Allergy 2022; 77:2222-2224. [PMID: 35122275 PMCID: PMC9305446 DOI: 10.1111/all.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/06/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lauré M. Fijen
- Department of Vascular Medicine Amsterdam Cardiovascular SciencesAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | - Remy S. Petersen
- Department of Vascular Medicine Amsterdam Cardiovascular SciencesAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam Cardiovascular SciencesAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
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23
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören‐Pürsün E, Banerji A, Bara N, Boccon‐Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos‐Fogelbach G, Hide M, Kang H, Kaplan AP, Katelaris C, Kiani‐Alikhan S, Lei W, Lockey R, Longhurst H, Lumry WB, MacGinnitie A, Malbran A, Martinez Saguer I, Matta JJ, Nast A, Nguyen D, Nieto‐Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Rafique Sheikh F, Smith WR, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2021 revision and update. Allergy 2022; 77:1961-1990. [PMID: 35006617 DOI: 10.1111/all.15214] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
Hereditary angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1 inhibitor (type 1) and HAE with dysfunctional C1 inhibitor (type 2), by providing guidance on common and important clinical issues, such as: (1) How should HAE be diagnosed? (2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? (3) What are the goals of treatment? (4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast-feeding women? and (5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Markus Magerl
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | | | - Werner Aberer
- Department of Dermatology Medical University of Graz Graz Austria
| | | | - Emel Aygören‐Pürsün
- Center for Children and Adolescents University Hospital Frankfurt Frankfurt Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital Boston Massachusetts USA
| | - Noémi‐Anna Bara
- Romanian Hereditary Angioedema Expertise CentreMediquest Clinical Research Center Sangeorgiu de Mures Romania
| | - Isabelle Boccon‐Gibod
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | - Konrad Bork
- Department of Dermatology University Medical CenterJohannes Gutenberg University Mainz Germany
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | | | - Nicholas Brodszki
- Department of Pediatric Immunology Childrens HospitalSkåne University Hospital Lund Sweden
| | | | - Anette Bygum
- Clinical Institute University of Southern Denmark Odense Denmark
- Department of Clinical Genetics Odense University Hospital Odense Denmark
| | - Teresa Caballero
- Allergy Department Hospital Universitario La PazIdiPaz, CIBERER U754 Madrid Spain
| | - Mauro Cancian
- Department of Systems Medicine University Hospital of Padua Padua Italy
| | | | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam UMC/University of Amsterdam Amsterdam The Netherlands
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Mark Gompels
- Clinical Immunology North Bristol NHS Trust Bristol UK
| | - Richard Gower
- Marycliff Clinical ResearchPrinciple Research Solutions Spokane Washington USA
| | | | | | - Michihiro Hide
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
- Department of Dermatology Hiroshima University Hiroshima Japan
| | - Hye‐Ryun Kang
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Allen Phillip Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology Medical university of South Carolina Charleston South Carolina USA
| | - Constance Katelaris
- Department of Medicine Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | | | - Wei‐Te Lei
- Division of Allergy, Immunology, and Rheumatology Department of Pediatrics Mackay Memorial Hospital Hsinchu Taiwan
| | - Richard Lockey
- Division of Allergy and Immunology Department of Internal Medicine Morsani College of MedicineUniversity of South Florida Tampa Florida USA
| | - Hilary Longhurst
- Department of Immunology Auckland District Health Board and Department of MedicineUniversity of Auckland Auckland New Zealand
| | - William B. Lumry
- Internal Medicine Allergy Division University of Texas Health Science Center Dallas Texas USA
| | - Andrew MacGinnitie
- Division of Immunology Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunología Clínica Buenos Aires Argentina
| | | | | | - Alexander Nast
- Department of Dermatology, Venereology and Allergology Division of Evidence‐Based Medicine Charité ‐ Universitätsmedizin Berlincorporate member of Free University of BerlinHumboldt University of Berlin, and Berlin Institute of Health Berlin Germany
| | - Dinh Nguyen
- Respiratory, Allergy and Clinical Immunology Unit Internal Medicine Department Vinmec Healthcare System College of Health SciencesVinUniversity Hanoi Vietnam
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Nieves Prior
- Allergy Hospital Universitario Severo Ochoa Madrid Spain
| | - Avner Reshef
- Angioderma CenterBarzilai University Medical Center Ashkelon Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology University of California San Diego La Jolla California USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology University of Alberta Edmonton AB Canada
| | - Farrukh Rafique Sheikh
- Section of Adult Allergy & Immunology Department of Medicine King Faisal Specialist Hospital & Research Centre Riyadh Saudi Arabia
| | - William R. Smith
- Clinical Immunology and Allergy Royal Adelaide Hospital Adelaide SA Australia
| | - Peter J. Spaeth
- Institute of PharmacologyUniversity of Bern Bern Switzerland
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Elias Toubi
- Division of Allergy and Clinical Immunology Bnai Zion Medical CenterAffiliated with Rappaport Faculty of MedicineTechnion‐Israel Institute of Technology Haifa Israel
| | - Lilian Agnes Varga
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Karsten Weller
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Andrea Zanichelli
- Department of Internal Medicine ASST Fatebenefratelli Sacco Ospedale Luigi Sacco‐University of Milan Milan Italy
| | - Yuxiang Zhi
- Department of Allergy and Clinical Immunology Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences Bejing China
| | - Bruce Zuraw
- University of California, San Diego San Diego California USA
| | - Timothy Craig
- Departments of Medicine and Pediatrics Penn State University Hershey Pennsylvania USA
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Abstract
Severe hypertriglyceridemia is a major risk factor for acute pancreatitis. In exceptional cases, it is caused by plasma components inhibiting lipoprotein lipase activity. This phenomenon is predominantly associated with autoimmune diseases. Here, we report a case of severe hypertriglyceridemia due to a transient reduction in lipoprotein lipase activity following an episode of COVID-19 in an otherwise healthy 45-year-old woman. The lipoprotein lipase activity of the patient was markedly reduced compared with a healthy control and did recover to 20% of the healthy control's lipoprotein lipase activity 5 months after the COVID-19 episode. Mixing tests substantiated reduced lipolytic capacity in the presence of the patient's plasma at presentation compared with a homozygous lipoprotein lipase-deficient control, which was no longer present at follow-up. Western blotting confirmed that the quantity of lipoprotein lipase was not aberrant. Fibrate treatment and a strict hypolipidemic diet improved the patient's symptoms and triglyceride levels.
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Affiliation(s)
- Lauré M Fijen
- Vascular Medicine, Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Aldo Grefhorst
- Experimental Vascular Medicine, Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Johannes H M Levels
- Experimental Vascular Medicine, Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Danny M Cohn
- Vascular Medicine, Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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25
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Fijen LM, Levi M, Cohn DM. COVID-19 vaccination and the risk of swellings in patients with hereditary angioedema. J Allergy Clin Immunol Pract 2021; 9:4156-4158. [PMID: 34534719 PMCID: PMC8438796 DOI: 10.1016/j.jaip.2021.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands
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26
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Li X, Weber NC, Cohn DM, Hollmann MW, DeVries JH, Hermanides J, Preckel B. Effects of Hyperglycemia and Diabetes Mellitus on Coagulation and Hemostasis. J Clin Med 2021; 10:jcm10112419. [PMID: 34072487 PMCID: PMC8199251 DOI: 10.3390/jcm10112419] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
In patients with diabetes, metabolic disorders disturb the physiological balance of coagulation and fibrinolysis, leading to a prothrombotic state characterized by platelet hypersensitivity, coagulation disorders and hypofibrinolysis. Hyperglycemia and insulin resistance cause changes in platelet number and activation, as well as qualitative and/or quantitative modifications of coagulatory and fibrinolytic factors, resulting in the formation of fibrinolysis-resistant clots in patients with diabetes. Other coexisting factors like hypoglycemia, obesity and dyslipidemia also contribute to coagulation disorders in patients with diabetes. Management of the prothrombotic state includes antiplatelet and anticoagulation therapies for diabetes patients with either a history of cardiovascular disease or prone to a higher risk of thrombus generation, but current guidelines lack recommendations on the optimal antithrombotic treatment for these patients. Metabolic optimizations like glucose control, lipid-lowering, and weight loss also improve coagulation disorders of diabetes patients. Intriguing, glucose-lowering drugs, especially cardiovascular beneficial agents, such as glucagon-like peptide-1 receptor agonists and sodium glucose co-transporter inhibitors, have been shown to exert direct anticoagulation effects in patients with diabetes. This review focuses on the most recent progress in the development and management of diabetes related prothrombotic state.
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Affiliation(s)
- Xiaoling Li
- Department of Anesthesiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.L.); (N.C.W.); (M.W.H.); (J.H.)
| | - Nina C. Weber
- Department of Anesthesiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.L.); (N.C.W.); (M.W.H.); (J.H.)
| | - Danny M. Cohn
- Department of Vascular Medicine, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.L.); (N.C.W.); (M.W.H.); (J.H.)
| | - J. Hans DeVries
- Department of International Medicine, Amsterdam UMC location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.L.); (N.C.W.); (M.W.H.); (J.H.)
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.L.); (N.C.W.); (M.W.H.); (J.H.)
- Correspondence: ; Tel.: +31-20-5669111
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27
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Hagen JM, Sutterland AL, Liefers T, Schirmbeck F, Cohn DM, Lok A, Tan HL, Zwinderman AH, de Haan L. Skin autofluorescence of advanced glycation end products and mortality in affective disorders in the lifelines cohort study: A mediation analysis. J Affect Disord 2021; 282:1082-1089. [PMID: 33601681 DOI: 10.1016/j.jad.2020.12.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Life expectancy in patients suffering from affective disorders is considerably diminished. We investigated whether skin autofluorescence (SAF), indicating concentration of advanced glycation end products in the skin and oxidative stress, mediates the association between affective disorders and excess mortality. METHODS Included were 81,041 participants of the Lifelines cohort study. Presence of major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia was assessed with the Mini-International Neuropsychiatric Interview. SAF was assessed as mediator in Cox proportional hazards models for all-cause or natural-cause mortality. RESULTS Mortality was increased in cases with major depression compared to controls (36.4 vs. 22.5 per 100,000 person years). Partial mediation by SAF of the association between affective disorders and mortality was shown (9.0-10.5%, P<.001-.002), although attenuated by cardiometabolic parameters and history of physical illness. For major depressive disorder, partial mediation by 5.5-10.3% was shown (crude model: P<.001; fully adjusted model: P=.03). LIMITATIONS The relatively short duration of follow-up and the relatively young cohort resulted in a lack of power to detect an association between mortality and dysthymia, social phobia and two or more comorbid disorders. CONCLUSION Evidence of partial mediation by SAF of the association between affective disorders and all-cause and natural-cause mortality was demonstrated, although attenuated by health factors. For major depression, mediation by SAF was largest and remained significant after adjustment for sociodemographic and health factors, identifying oxidative stress as possible determinant of premature death.
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Affiliation(s)
- Julia M Hagen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands.
| | - Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Tessa Liefers
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Arkin Mental Health Institute, Amsterdam, the Netherlands
| | - Danny M Cohn
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hanno L Tan
- The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Arkin Mental Health Institute, Amsterdam, the Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
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28
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Abstract
Hereditary angioedema (HAE) is a rare disease that causes episodic attacks of subcutaneous and submucosal edema, which can be painful, incapacitating, and potentially fatal. These attacks are mediated by excessive bradykinin production, as a result of uncontrolled activation of the plasma kallikrein/kinin system, which is caused by a C1 esterase inhibitor deficiency or dysfunction in HAE types 1 and 2, respectively. For many years, treatment options were limited to therapies with substantial adverse effects, insufficient efficacy, or difficult routes of administration. Increased insights in the pathophysiology of HAE have paved the way for the development of new therapies with fewer side effects. In the last two decades, several targeted novel therapeutic strategies for HAE have been developed, for both long-term prophylaxis and on demand treatment of acute attacks. This article reviews the advances in the development of more effective and convenient treatment options for HAE and their anticipated effects on morbidity, mortality, and quality of life. The emergence of these improved treatment options will presumably change current HAE guidelines, but adherence to these recommendations may become restricted by high treatment costs. It will therefore be essential to determine the indications and identify the patients that will benefit most from these newest treatment generations. Ultimately, current preclinical research into gene therapies may eventually lead the way towards curative treatment options for HAE. In conclusion, an increasing shift towards the use of highly effective long-term prophylaxis is anticipated, which should drastically abate the burden on patients with hereditary angioedema.
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Affiliation(s)
- Lauré M Fijen
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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29
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Hagen JM, Sutterland AL, Schirmbeck F, Cohn DM, Lok A, Tan HL, Zwinderman AH, de Haan L. Skin autofluorescence of advanced glycation end products and course of affective disorders in the lifelines cohort study, a prospective investigation. J Affect Disord 2020; 276:424-432. [PMID: 32871673 DOI: 10.1016/j.jad.2020.07.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Skin autofluorescence (SAF), indicating concentration of advanced glycation end products in the skin and oxidative stress, is cross-sectionally associated with affective disorders. Prospective studies of oxidative stress markers will help to clarify the pathophysiological role of oxidative stress. METHODS Data of a population-based cohort study were used. Presence of major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia was assessed at baseline and at 5-year follow-up with the Mini-International Neuropsychiatric Interview. Associations between SAF at baseline and incidence and persistence/recurrence of affective disorders were assessed with logistic regression. RESULTS Of 43,267 participants with no disorder at baseline, 2885 (6.7%) developed an incident disorder during follow-up. In 1360 of 3648 participants (37.3%) with an affective disorder at baseline, a persisting/recurrent disorder was present at follow-up. A modest association existed between SAF and incident affective disorders (OR=1.07 [95%CI 1.03-1.12], P<.001), specifically major depressive disorder (OR=1.11 [95%CI 1.04-1.19], P=.003); this association lost statistical significance after adjustment for sociodemographic factors. Associations between SAF and persistence/recurrence were not significant. LIMITATIONS Many confounders might also act as intermediate: extensive adjustment for confounders caused overfitting and possibly masked effects of SAF on course of affective disorders. Relatively small sample sizes for analyses of SAF and persistence/recurrence of affective disorders resulted in a low power. CONCLUSIONS Increased SAF modestly raises the odds of incident affective disorders, particularly major depressive disorder, providing evidence that oxidative stress plays a role in subsequent occurrence of affective disorders. However, significance of effects faded after adjustment for socioeconomic status.
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Affiliation(s)
- Julia M Hagen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands
| | - Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands; Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Danny M Cohn
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam, Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Hanno L Tan
- The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, Netherlands; Netherlands Heart Institute, Utrecht, Netherlands
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands; Arkin Mental Health Institute, Amsterdam, Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Netherlands
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30
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Hagen JM, Sutterland AL, da Fonseca Pereira de Sousa PAL, Schirmbeck F, Cohn DM, Lok A, Tan HL, Zwinderman AH, de Haan L. Association between skin autofluorescence of advanced glycation end products and affective disorders in the lifelines cohort study. J Affect Disord 2020; 275:230-237. [PMID: 32734913 DOI: 10.1016/j.jad.2020.06.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oxidative stress may be a mechanistic link between affective disorders (depressive and anxiety disorders) and somatic disease. Advanced glycation end products are produced under the influence of oxidative stress and in the skin (measured by skin autofluorescence [SAF]) serve as marker for cumulative oxidative stress. Aim of study was to determine whether SAF is associated with presence of affective disorders. METHODS Participants in the Lifelines cohort study who had completed the Mini-International Neuropsychiatric Interview for affective disorders and a SAF-measurement were included. Cross-sectional associations between SAF and presence of the following psychiatric disorders were investigated through logistic regression analyses adjusted for sociodemographic factors, cardiometabolic parameters, and somatic morbidities: major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia. RESULTS Of 81,041 included participants (41.7% male, aged 18-91 years), 6676 (8.2%) were cases with an affective disorder. SAF was associated with presence of affective disorders (OR=1.09 [95%CI 1.07-1.12], P<.001 adjusted for sociodemographic factors). Association with major depressive disorder was strongest and significant after adjustment for all confounders (OR=1.31 [95%CI 1.25-1.36], P<.001 in the crude model; OR=1.12 [95%CI 1.07-1.17], P<.001 in the fully adjusted model). For other disorders, associations lost significance after adjustment for cardiometabolic parameters and somatic morbidities. LIMITATIONS Persons of non-Western descent and severely (mentally or physically) ill individuals were underrepresented. CONCLUSIONS SAF was associated with presence of affective disorders, suggesting a link between these disorders and cumulative oxidative stress. For major depressive disorder, this association was strongest and independent of sociodemographic, cardiometabolic factors, and somatic morbidities.
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Affiliation(s)
- Julia M Hagen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands
| | - Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands.
| | | | - Frederike Schirmbeck
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands; Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Danny M Cohn
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam, Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Hanno L Tan
- The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, Netherlands; Netherlands Heart Institute, Utrecht, Netherlands
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, Netherlands; Arkin Mental Health Institute, Amsterdam, Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Netherlands
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31
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Cohn DM, Viney NJ, Fijen LM, Schneider E, Alexander VJ, Xia S, Kaeser GE, Nanavati C, Baker BF, Geary RS, Levi M, Meijers JCM, Stroes ESG. Antisense Inhibition of Prekallikrein to Control Hereditary Angioedema. N Engl J Med 2020; 383:1242-1247. [PMID: 32877578 DOI: 10.1056/nejmoa1915035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hereditary angioedema is characterized by recurrent and unpredictable episodes of subcutaneous and mucosal swelling that can be life threatening. IONIS-PKK-LRx is a ligand-conjugated antisense oligonucleotide designed for receptor-mediated delivery to hepatocytes. In a compassionate-use pilot study, two patients with severe bradykinin-mediated angioedema were initially administered weekly subcutaneous injections of the unconjugated parent drug, IONIS-PKKRx, for 12 to 16 weeks, after which they received IONIS-PKK-LRx at a dose of 80 mg every 3 to 4 weeks for 7 to 8 months. Treatment was accompanied by a reduction in the angioedema attack rate. (Funded by Amsterdam UMC.).
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Affiliation(s)
- Danny M Cohn
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Nicholas J Viney
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Lauré M Fijen
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Eugene Schneider
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Veronica J Alexander
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Shuting Xia
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Gwendolyn E Kaeser
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Charvi Nanavati
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Brenda F Baker
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Richard S Geary
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Marcel Levi
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Joost C M Meijers
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
| | - Erik S G Stroes
- From the Departments of Vascular Medicine (D.M.C., L.M.F., E.S.G.S.) and Experimental Vascular Medicine (J.C.M.M.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, and the Department of Molecular and Cellular Hemostasis, Sanquin Research (J.C.M.M.), Amsterdam; Ionis Pharmaceuticals, Carlsbad, CA (N.J.V., E.S., V.J.A., S.X., G.E.K., C.N., B.F.B., R.S.G.); and the Department of Medicine, University College London Hospitals NHS Foundation Trust, and the Cardiometabolic Programme, National Institute for Health Research University College London Hospitals and University College London Biomedical Research Centre, London (M.L.)
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Maurer M, Aberer W, Agondi R, Al‐Ahmad M, Al‐Nesf MA, Ansotegui I, Arnaout R, Arruda LK, Asero R, Aygören‐Pürsün E, Banerji A, Bauer A, Ben‐Shoshan M, Berardi A, Bernstein JA, Betschel S, Bindslev‐Jensen C, Bizjak M, Boccon‐Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Broesby‐Olsen S, Busse P, Buttgereit T, Bygum A, Caballero T, Campos RA, Cancian M, Cherrez‐Ojeda I, Cohn DM, Costa C, Craig T, Criado PR, Criado RF, Csuka D, Dissemond J, Du‐Thanh A, Ensina LF, Ertaş R, Fabiani JE, Fantini C, Farkas H, Ferrucci SM, Figueras‐Nart I, Fili NL, Fomina D, Fukunaga A, Gelincik A, Giménez‐Arnau A, Godse K, Gompels M, Gonçalo M, Gotua M, Gower R, Grumach AS, Guidos‐Fogelbach G, Hide M, Ilina N, Inomata N, Jakob T, Josviack DO, Kang H, Kaplan A, Kasperska‐Zając A, Katelaris C, Kessel A, Kleinheinz A, Kocatürk E, Košnik M, Krasowska D, Kulthanan K, Kumaran MS, Larco Sousa JI, Longhurst HJ, Lumry W, MacGinnitie A, Magerl M, Makris MP, Malbrán A, Marsland A, Martinez‐Saguer I, Medina IV, Meshkova R, Metz M, Nasr I, Nicolay J, Nishigori C, Ohsawa I, Özyurt K, Papadopoulos NG, Parisi CAS, Peter JG, Pfützner W, Popov T, Prior N, Ramon GD, Reich A, Reshef A, Riedl MA, Ritchie B, Röckmann‐Helmbach H, Rudenko M, Salman A, Sanchez‐Borges M, Schmid‐Grendelmeier P, Serpa FS, Serra‐Baldrich E, Sheikh FR, Smith W, Soria A, Staubach P, Steiner UC, Stobiecki M, Sussman G, Tagka A, Thomsen SF, Treudler R, Valle S, Doorn M, Varga L, Vázquez DO, Wagner N, Wang L, Weber‐Chrysochoou C, Ye Y, Zalewska‐Janowska A, Zanichelli A, Zhao Z, Zhi Y, Zuberbier T, Zwiener RD, Castaldo A. Definition, aims, and implementation of GA 2 LEN/HAEi Angioedema Centers of Reference and Excellence. Allergy 2020; 75:2115-2123. [PMID: 32248571 DOI: 10.1111/all.14293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Werner Aberer
- Department of Dermatology Medical University of Graz Graz Austria
| | | | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Safat Kuwait
| | - Maryam Ali Al‐Nesf
- Allergy and Immunology Section Department of Medicine Hamad General Hospital Doha Qatar
| | - Ignacio Ansotegui
- Department of Allergy and Immunology Hospital Quiron Bizkaia Bizkaia Spain
| | - Rand Arnaout
- King Faisal Specialist Hospital & Research Center Al Faisal University Riyadh Saudi Arabia
| | | | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Emel Aygören‐Pürsün
- Center for Children and Adolescents University Hospital Frankfurt Frankfurt Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital Boston MA USA
| | - Andrea Bauer
- Department of Dermatology University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Germany
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics McGill University Health Center Montreal QC Canada
| | - Alejandro Berardi
- Instituto de Asma Alergia y Enfermedades Respiratorias Corrientes Argentina
| | - Jonathan A. Bernstein
- Allergy Section Division of Immunology Department of Internal Medicine Partner Bernstein Allergy Group Partner Bernstein Clinical Research Center University of Cincinnati Cincinnati OH USA
| | - Stephen Betschel
- Division of Clinical Immunology and Allergy St. Michael’s Hospital University of Toronto Toronto ON Canada
| | | | - Mojca Bizjak
- Division of Allergy University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Isabelle Boccon‐Gibod
- Clinical Immunology/Internal Medicine Department National Reference Center for Angioedema Grenoble University Hospital Grenoble France
| | - Konrad Bork
- Department of Dermatology Johannes Gutenberg University Mainz Mainz Germany
| | - Laurence Bouillet
- Clinical Immunology/Internal Medicine Department National Reference Center for Angioedema Grenoble University Hospital Grenoble France
| | | | | | - Sigurd Broesby‐Olsen
- Department of Dermatology and Allergy Center Odense University Hospital Odense Denmark
| | - Paula Busse
- Division of Clinical Immunology Icahn School at Mount Sinai New York NY USA
| | - Thomas Buttgereit
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Anette Bygum
- HAE Centre Odense University Hospital Odense Denmark
| | - Teresa Caballero
- Allergy Department Hospital Universitario La Paz IdiPaz, CIBERER U754 Madrid Spain
| | - Régis A. Campos
- Universidade Federal da Bahia Salvador Brazil
- Serviço de Imunologia Hospital das Clínicas Professor Edgard Santos Salvador Brazil
| | - Mauro Cancian
- Department of Systems Medicine University Hospital of Padua Padua Italy
| | - Ivan Cherrez‐Ojeda
- School of Medicine Universidad de Especialidades Espíritu Santo Samborondón Ecuador
- RespiraLab, Research Guayaquil Ecuador
| | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Célia Costa
- Immunoallergology Department Hospital de Santa Maria Centro Hospitalar Universitário de Lisboa Norte (CHLN) EPE Lisbon Portugal
| | - Timothy Craig
- Department of Medicine and Pediatrics Penn State University Hershey PA USA
| | - Paulo Ricardo Criado
- Faculdade de Medicina do ABC Santo André Brazil
- Alergoskin Alergia e Dermatologia SS ltda Santo André Brazil
- UCARE Center São Paulo Brazil
| | | | - Dorottya Csuka
- 3rd Department of Internal Medicine Hungarian Angioedema Reference Center Semmelweis University Budapest Hungary
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology University of Essen Essen Germany
| | - Aurélie Du‐Thanh
- Service de Dermatologie‐allergologie CHU Montpellier Montpellier Cedex 5 France
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Ragıp Ertaş
- Department of Dermatology Kayseri City Education and Research Hospital Kayseri Turkey
| | | | - Claudio Fantini
- Servicio de Alergia e Inmunología—Hospital Alende y Clínica Colón Mar del Plata Argentina
| | - Henriette Farkas
- 3rd Department of Internal Medicine Hungarian Angioedema Reference Center Semmelweis University Budapest Hungary
| | - Silvia Mariel Ferrucci
- Ambulatorio di Dermatologia Allergologica e Professionale Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano (MI) Italy
| | - Ignasi Figueras‐Nart
- The Dermatology Department of the Hospital de Bellvitge Universitat de Barcelona Barcelona Spain
| | - Natalia L. Fili
- Unidad Alergia e Inmunología Clínica Hospital Público Materno Infantil Salta Argentina
| | - Daria Fomina
- Center of Allergy and Immunology City Clinical Hospital No. 52 Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Atsushi Fukunaga
- Division of Dermatology Graduate School of Medicine Kobe University Kobe Japan
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y. Patil University School of Medicine Mumbai India
| | - Mark Gompels
- Department of Immunology North Bristol NHS Trust Southmead Hospital Bristol UK
| | - Margarida Gonçalo
- Clinica de Dermatologia Centro Hospitalar Universitário Coimbra Coimbra Portugal
| | - Maia Gotua
- Center of Allergy and Immunology Tbilsi Georgia
| | | | - Anete S. Grumach
- Clinical Immunology Medical School University Center Health ABC Santo Andre Brazil
| | | | - Michihiro Hide
- Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | | | - Naoko Inomata
- Department of Environmental Immuno‐Dermatology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Thilo Jakob
- Department of Dermatology and Allergy University Medical Center Giessen (UKGM) Justus‐Liebig‐University Giessen Giessen Germany
| | | | - Hye‐Ryun Kang
- Institute of Allergy and Clinical Immunology Seoul National University Medical Research Center Seoul Korea
| | - Allen Kaplan
- Medical University of South Carolina Charleston SC USA
| | | | - Constance Katelaris
- Immunology & Allergy Unit Department of Medicine Campbelltown Hospital Campbelltown NSW Australia
| | - Aharon Kessel
- Division of Allergy & Clinical Immunology Rappaport Faculty of Medicine Bnai Zion Medical Center Technion Haifa Israel
| | | | - Emek Kocatürk
- Department of Dermatology School of Medicine Koç University Koc Turkey
| | - Mitja Košnik
- Division of Allergy University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Dorota Krasowska
- Department of Dermatology, Venerology and Pediatric Dermatology Medical University of Lublin Lublin Poland
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - M. Sendhil Kumaran
- Department of Dermatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | | | - Hilary J. Longhurst
- Department of Immunology Addenbrookes Hospital Cambridge University NHS Foundation Trust Cambridge UK
- UCLH London UK
- Addenbrooke's Hospital Cambridge and University College Hospital London UK
| | - William Lumry
- Allergy/Immunology Division Department of Internal Medicine University of Texas Southwestern Medical School Dallas TX USA
| | - Andrew MacGinnitie
- Division of Immunology Department of Pediatrics Boston Children’s Hospital Harvard Medical School Boston MA USA
| | - Markus Magerl
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Michael P. Makris
- Allergy Unit “D. Kalogeromitros” 2nd Department of Dermatology and Venereology University Hospital “Attikon”, National and Kapodistrian University of Athens Athens Greece
| | | | - Alexander Marsland
- Department of Dermatology The Urticaria Clinic Salford Royal Foundation Trust University of Manchester Manchester UK
| | | | - Iris V. Medina
- Allergy and Clinical Immunology Department Centro Médico Vitae de Julio Argentina
| | - Raisa Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russian Federation
| | - Martin Metz
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Iman Nasr
- Adult Immunology and Allergy Unit Department of Medicine Royal Hospital Muscat Oman
| | - Jan Nicolay
- Klinik für Dermatologie Universitätsklinikum Mannheim Mannheim Germany
| | - Chikako Nishigori
- Division of Dermatology Kobe University Graduate School of Medicine Kobe Japan
| | - Isao Ohsawa
- Department of Internal Medicine Saiyu Soka Hospital Soka Japan
| | - Kemal Özyurt
- Department of Dermatology Faculty of Medicine Kırşehir Ahi Evran University Kırşehir Turkey
| | | | - Claudio A. S. Parisi
- Adults and Pediatrics Allergy Unit Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | | | - Wolfgang Pfützner
- Department of Dermatology and Allergology Allergy Center Hessen University Clinic Marburg Marburg Germany
| | - Todor Popov
- University Hospital Sv. Ivan Rilski Sofia Bulgaria
| | - Nieves Prior
- Allergy Department Hospital Universitario Severo Ochoa Madrid Spain
| | - German D. Ramon
- Instituto de Alergia e Inmunologia del Sur Buenos Aires Argentina
| | - Adam Reich
- Department of Dermatology University of Rzeszow Rzeszów Poland
| | - Avner Reshef
- Angioedema Center Barzilai Medical Center Ashkelon Israel
| | - Marc A. Riedl
- Department of Medicine University of California—San Diego La Jolla CA USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology University of Alberta Edmonton AB Canada
| | - Heike Röckmann‐Helmbach
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Andaç Salman
- Dermatology Department Marmara University School of Medicine Pendik Research and Training Hospital Istanbul Turkey
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico Docente La Trinidad Caracas Venezuela
| | | | - Faradiba S. Serpa
- Hospital Santa Casa de Misericórdia de Vitória Espírito Santo Brazil
| | | | - Farrukh R. Sheikh
- Department of Medicine King Faisal Specialist Hospital & Research Center Riyadh Saudi Arabia
| | - William Smith
- Clinical Immunology and Allergy Royal Adelaide Hospital Adelaide SA Australia
| | - Angèle Soria
- Service de Dermatologie et Allergologie Hopital Tenon APHP Sorbonne Université Paris France
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz Germany
| | - Urs C. Steiner
- Department of Clinical Immunology University Hospital Zurich Zurich Switzerland
| | - Marcin Stobiecki
- Department of Environmental Allergology Jagiellonian University Medical College Kraków HAE Center University Hospital Kraków Poland
| | - Gordon Sussman
- Division of Allergy and Immunology University of Toronto Toronto ON Canada
| | - Anna Tagka
- First Department of Dermatology and Venereology National and Kapodistrian University of Athens, "A. Syggros" Hospital Referral Center of Occupational Dermatological Diseases Athens Greece
| | | | - Regina Treudler
- Department of Dermatology, Venerology and Allergology and Leipzig Interdisciplinary Center of Allergology—Comprehensive Allergy Center UMC Leipzig Leipzig Germany
| | - Solange Valle
- Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Martijn Doorn
- Department of Dermatology Erasmus MC Rotterdam The Netherlands
| | - Lilian Varga
- 3rd Department of Internal Medicine Hungarian Angioedema Reference Center Semmelweis University Budapest Hungary
| | | | - Nicola Wagner
- Department of Dermatology University of Erlangen Erlangen Germany
| | - Liangchun Wang
- Dermatology Department of Sun Yat‐sen Memorial Hospital Guangzhou China
| | | | - Young‐Min Ye
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon Korea
| | - Anna Zalewska‐Janowska
- Chair of Clinical Immunology and Rheumatology Department of Psychodermatology Medical University of Lodz Lodz Poland
| | - Andrea Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco Hospital University of Milan Milan Italy
| | - Zuotao Zhao
- Department of Dermatology and Venereology First Hospital Peking University Beijing China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses Beijing China
| | - Yuxiang Zhi
- Department of Allergy Peking Union Medical College Hospital & Chinese Academy of Medical Sciences Beijing China
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Ricardo D. Zwiener
- Servicio de Alergia e Inmunología Hospital Universitario Austral Buenos Aires Argentina
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Cohn DM, Arruda LK. Preventing Deaths from Angioedema: It's Time to Look Ahead. J Allergy Clin Immunol Pract 2020; 8:1775-1776. [PMID: 32389281 DOI: 10.1016/j.jaip.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Danny M Cohn
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam, The Netherlands.
| | - L Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Levi M, Cohn DM. The Role of Complement in Hereditary Angioedema. Transfus Med Rev 2019; 33:243-247. [DOI: 10.1016/j.tmrv.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022]
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35
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Cohn DM, Zeerleder SS, Meijers JCM, Stroes ESG, Levi M. Albumin plasma exchange for life-threatening angioedema with normal C1-inhibitor. J Allergy Clin Immunol Pract 2019; 7:1360-1361. [PMID: 30967195 DOI: 10.1016/j.jaip.2018.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/31/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Danny M Cohn
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sacha S Zeerleder
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; University College London Hospitals NHS Foundation Trust, Department of Medicine, London, United Kingdom; Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, United Kingdom
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Yang SR, van de Stolpe A, van Brussel A, van Ooijen H, Galimzianova A, Cohn DM, Beca F, Rubin DL, Allison KH. Abstract P5-11-06: Does hormone expression by IHC predict ER pathway activity? An analysis in a metastatic breast cancer patient cohort. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-11-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Immunohistochemistry (IHC) staining for ER and progesterone (PR) receptors in breast cancer tissue is the current standard for testing for eligibility for hormone targeted therapies. However, these markers are imperfect predictors of response, and ER/PR expression can be heterogeneous, especially in the metastatic setting. Within an adjuvant tamoxifen-treated ER positive patient group functional ER pathway activity was associated with improved patient outcome (Verhaegh et al, Cancer Research 2014). This study investigated how ER/PR staining correlates with ER pathway activity in a cohort of metastatic breast cancers.
Methods: Cases of metastatic breast cancer with variable reported ER expression by IHC were selected from the Stanford Pathology Database. Cases were scored by a breast pathologist for percent cellularity of sample, percent and intensity of ER and PR staining, and a qualitative rating of heterogeneity of staining. Digital slides were annotated for areas of cellularity to perform ER pathway activity analysis. Functional ER pathway activitywas measured in a quantitative manner using a biologically validated method, based on Bayesian computational model inference of functional pathway activity from RT-qPCR measurements of mRNA levels of target genes of the pathway transcription factor, providing an ER Pathway Activity Score (PAS)(Verhaegh et al, Cancer Research 2014).
Results: A total of 64 samples were tested for ER/PR expression as well as for ER pathway analysis. Annotated tumor areas of 57 samples were used for measurement of ER PAS. 61.4% were ER expression high (defined as >50% ER IHC positive, mean 94.0%) and 38.6 % were ER low (defined as <50% ER IHC positive, mean 23.0%). ER high cases had higher mean ER PAS when compared to ER low cases (ER high, mean PAS 47.6, SD 19.2; versus ER low, mean PAS 19.4, SD 11.7; unpaired one-tailed 2-sample t-test p<0.001). Importantly, there was wide variation in ER PAS even in cases with high ER expression levels. PR levels did not correlate with ER PAS. Three cases had clustered areas with different ER expression levels within the tissue slide (heterogeneous cases), resulting in 7 separately analyzed areas; ER pathway activity was separately analyzed in these areas. ER PAS was remarkably similar across areas with variable ER staining, e.g. within one tissue slide, areas with 20% and 90% ER expression had nearly the same ER PAS.
Discussion: Grouping cases into high vs low ER IHC staining reveals expected differences in ER PAS. However, nuclear ER expression (IHC) levels may be an imperfect predictor of actual ER pathway activity on an individual case basis. Preliminary results on cases with regional heterogeneity for levels of ER IHC expression suggest that ER PAS is more homogenous than IHC levels. Clinical studies examining value of ER PAS to predict response to hormonal therapies are ongoing.
Citation Format: Yang S-R, van de Stolpe A, van Brussel A, van Ooijen H, Galimzianova A, Cohn DM, Beca F, Rubin DL, Allison KH. Does hormone expression by IHC predict ER pathway activity? An analysis in a metastatic breast cancer patient cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-11-06.
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Affiliation(s)
- S-R Yang
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - A van de Stolpe
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - A van Brussel
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - H van Ooijen
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - A Galimzianova
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - DM Cohn
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - F Beca
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - DL Rubin
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
| | - KH Allison
- Stanford University School of Medicine, Stanford, CA; Precision & Decentralized Diagnostics, Philips Research, Eindhoven, Netherlands
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Levi M, Cohn DM, Zeerleder S. Hereditary angioedema: Linking complement regulation to the coagulation system. Res Pract Thromb Haemost 2019; 3:38-43. [PMID: 30656274 PMCID: PMC6332742 DOI: 10.1002/rth2.12175] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/12/2018] [Indexed: 12/20/2022] Open
Abstract
Congenital deficiency of C1 inhibitor, the main inhibitor of the classic complement system pathway, leads to paroxysmal angioedema (hereditary angioedema) that can be debilitating or life-threatening for affected patients. In the past few years many new insights on the pathogenesis of angioedema formation in the presence of low levels of C1 inhibitor has been accumulated. There is a central role for bradykinin that is released upon activation of the kallikrein-kinin system that is insufficiently controlled by adequate levels of C1 inhibitor. As C1 inhibitor also possesses a central regulatory role of other plasma systems, including the contact activation system of coagulation and the plasminogen-plasmin system that governs endogenous fibrinolysis, it is interesting to observe the effects of C1 inhibitor deficiency on activation of these systems and relevance for hemostasis in vivo and thrombo-embolic disease. Interestingly, and despite significant activation of these pathways, C1 inhibitor deficiency is not at all associated with a hemorrhagic tendency or prothrombotic state. New therapeutic options for treatment of C1 inhibitor efficiency have become available in recent years, including various forms of C1 inhibitor concentrate. Restoration of C1 inhibitor levels in patients with hereditary angioedema has not resulted in thrombotic complications or any other relevant disorder associated with the hemostatic system.
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Affiliation(s)
- Marcel Levi
- Department of MedicineUniversity College London HospitalsNHS Foundation TrustLondonUK
- Cardiometabolic ProgrammeUniversity College London HospitalsNHS Foundation TrustLondonUK
- Department of Vascular MedicineAmsterdam Universities Medical CenterAmsterdamThe Netherlands
| | - Danny M. Cohn
- Department of Vascular MedicineAmsterdam Universities Medical CenterAmsterdamThe Netherlands
| | - Sacha Zeerleder
- Department of Molecular Cell BiologySanquin Research & Landsteiner LaboratoryAmsterdamThe Netherlands
- Department of Hematology and Central Hematology LaboratoryInselspitalBern University HospitalBernSwitzerland
- Department for BioMedical ResearchBern University HospitalBernSwitzerland
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Akaberi A, Klok FA, Cohn DM, Hirsch A, Granton J, Kahn SR. Determining the minimal clinically important difference for the PEmbQoL questionnaire, a measure of pulmonary embolism-specific quality of life. J Thromb Haemost 2018; 16:2454-2461. [PMID: 30240543 DOI: 10.1111/jth.14302] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Indexed: 11/30/2022]
Abstract
Essentials The minimal clinically important difference (MCID) for PEmbQoL has not yet been determined. We estimated the MCID for PEmbQoL and its subscales via anchor- and distribution-based approaches. Our results indicate that MCID for PEmbQoL appears to be 15 points. Our work enables interpretation of changes or differences in PEmbQoL. SUMMARY: Background Pulmonary embolism (PE) reduces quality of life (QOL). The PEmbQoL questionnaire, a PE-related QOL measure, was recently developed and validated and has been used to quantify disease-specific QOL in clinical studies of patients with PE. However, to date, interpretation of PEmbQoL scores has been limited by a lack of information on the minimal clinically important difference (MCID) of this measure. Objective To determine the MCID for PEmbQoL and its subscales using anchor-based and distribution-based approaches. Methods We analyzed data from the ELOPE Study, a prospective, multicenter cohort study of long-term outcomes after a first episode of acute PE. At baseline and 1, 3, 6 and 12 months after PE, we measured generic QOL (SF-36), PE-specific QOL (PEmbQoL) and dyspnea severity (UCSD Shortness of Breath Questionnaire). We used time-varying repeated-measures mixed-effect models to estimate anchor-based MCID and effect sizes to estimate distribution-based MCID. Results Eighty-two patients participated in this sub-study. Their mean age was 49.4 years, 60% were male and 84% had PE diagnosed in an outpatient setting. Using both anchor- and distribution-based approaches, the MCID for PEmbQoL appears to be 15 points. Based on this MCID, 42%, 59%, 66% and 75% of patients experienced at least one MCID unit of improvement in PEmbQoL from baseline to 1, 3, 6 and 12 months, respectively. Conclusion Our results provide new information on the MCID of PEmbQoL, a PE-specific QOL questionnaire that can be used by researchers and clinicians to measure and interpret changes in PE-specific QOL over time, or as an outcome in clinical trials.
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Affiliation(s)
- A Akaberi
- Center for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - D M Cohn
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A Hirsch
- Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - J Granton
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S R Kahn
- Center for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
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Murphy MO, Cohn DM, Loria AS. Developmental origins of cardiovascular disease: Impact of early life stress in humans and rodents. Neurosci Biobehav Rev 2017; 74:453-465. [PMID: 27450581 PMCID: PMC5250589 DOI: 10.1016/j.neubiorev.2016.07.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 02/07/2023]
Abstract
The Developmental Origins of Health and Disease (DOHaD) hypothesizes that environmental insults during childhood programs the individual to develop chronic disease in adulthood. Emerging epidemiological data strongly supports that early life stress (ELS) given by the exposure to adverse childhood experiences is regarded as an independent risk factor capable of predicting future risk of cardiovascular disease. Experimental animal models utilizing chronic behavioral stress during postnatal life, specifically maternal separation (MatSep) provides a suitable tool to elucidate molecular mechanisms by which ELS increases the risk to develop cardiovascular disease, including hypertension. The purpose of this review is to highlight current epidemiological studies linking ELS to the development of cardiovascular disease and to discuss the potential molecular mechanisms identified from animal studies. Overall, this review reveals the need for future investigations to further clarify the molecular mechanisms of ELS in order to develop more personalized therapeutics to mitigate the long-term consequences of chronic behavioral stress including cardiovascular and heart disease in adulthood.
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Affiliation(s)
- M O Murphy
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - D M Cohn
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - A S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States.
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Rochat M, Méan M, Limacher A, Hugli O, Klok FA, Cohn DM, Aujesky D. Quality of life after pulmonary embolism: validation of the French version of the PEmb-QoL questionnaire. Health Qual Life Outcomes 2014; 12:174. [PMID: 25464821 PMCID: PMC4260180 DOI: 10.1186/s12955-014-0174-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 11/15/2014] [Indexed: 01/22/2023] Open
Abstract
Background The PEmb-QoL is a validated 40-item questionnaire to quantify health-related quality of life in patients having experienced pulmonary embolism (PE). It covers six health dimensions: frequency of complaints, activities of daily living limitations, work-related problems, social limitations, intensity of complaints, and emotional complaints. Originally developed in Dutch and English, we sought to prospectively validate the psychometric properties of a French version of the PEmb-QoL. Methods We performed a forward and backward translation of the English version of the PEmb-QoL into French. French-speaking consecutive adult patients with an acute, objectively confirmed PE admitted to the emergency department of a Swiss university hospital between 08/2009 and 09/2011 were recruited telephonically. We used standard psychometric tests and criteria to evaluate the acceptability, reliability, and validity of the French version of the PEmb-QoL. We also performed an exploratory factor analysis. Results Overall, 102 patients were enrolled in the study. The French version of the PEmb-QoL showed good reliability (internal consistency, item–total and inter-item correlations), reproducibility (test-retest reliability), and validity (convergent, discriminant) in French-speaking patients with PE. The exploratory factor analysis suggested three underlying dimensions: limitations in daily activity (items 4b-m, 5a-d), symptoms (items 1a-h and 7), and emotional complaints (items 9a-f and j). Conclusion We successfully validated the French version of the PEmb-QoL questionnaire in patients with PE. Our results show that the PEmb-QoL is a valuable tool for assessing health-related quality of life after PE in French-speaking patients. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0174-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mathilde Rochat
- Department of Internal Medicine, Lausanne University Hospital, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Marie Méan
- Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
| | - Andreas Limacher
- Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), CTU Bern, University of Bern, Bern, Switzerland.
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - Danny M Cohn
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
| | - Drahomir Aujesky
- Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
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van Es J, den Exter PL, Kaptein AA, Andela CD, Erkens PMG, Klok FA, Douma RA, Mos ICM, Cohn DM, Kamphuisen PW, Huisman MV, Middeldorp S. Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL. Thromb Res 2013; 132:500-5. [PMID: 24090607 DOI: 10.1016/j.thromres.2013.06.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/12/2013] [Accepted: 06/16/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although quality of life (QoL) is recognized as an important indicator of the course of a disease, it has rarely been addressed in studies evaluating the outcome of care for patients with pulmonary embolism (PE). This study primarily aimed to evaluate the QoL of patients with acute PE in comparison to population norms and to patients with other cardiopulmonary diseases, using a generic QoL questionnaire. Secondary, the impact of time period from diagnosis and clinical patient characteristics on QoL was assessed, using a disease-specific questionnaire. METHODS QoL was assessed in 109 consecutive out-patients with a history of objectively confirmed acute PE (mean age 60.4 ± 15.0 years, 56 females), using the generic Short Form-36 (SF-36) and the disease specific Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL). The score of the SF-36 were compared with scores of the general Dutch population and reference populations with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), a history of acute myocardial infarction (AMI), derived from the literature. Scores on the SF-35 and PEmb-QoL were used to evaluate QoL in the short-term and long-term clinical course of patients with acute PE. In addition, we examined correlations between PEmb-QoL scores and clinical patient characteristics. RESULTS Compared to scores of the general Dutch population, scores of PE patients were worse on several subscales of the SF-36 (social functioning, role emotional, general health (P<0.001), role physical and vitality (P<0.05)). Compared to patients with COPD and CHF, patients with PE scored higher (=better) on all subscales of the SF-36 (P ≤ 0.004) and had scores comparable with patients with AMI the previous year. Comparing intermediately assessed QoL with QoL assessed in long-term follow-up, PE patients scored worse on SF-36 subscales: physical functioning, social functioning, vitality (P<0.05), and on the PEmb-QoL subscales: emotional complaints and limitations in ADL (P ≤ 0.03). Clinical characteristics did not correlate with QoL as measured by PEmb-QoL. CONCLUSION Our study demonstrated an impaired QoL in patients after treatment of PE. The results of this study provided more knowledge about QoL in patients treated for PE.
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Affiliation(s)
- Josien van Es
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
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van den Boogaard E, Cohn DM, Korevaar JC, Dawood F, Vissenberg R, Middeldorp S, Goddijn M, Farquharson RG. Number and sequence of preceding miscarriages and maternal age for the prediction of antiphospholipid syndrome in women with recurrent miscarriage. Fertil Steril 2013; 99:188-192. [DOI: 10.1016/j.fertnstert.2012.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Tests for thrombophilia are being performed on a large scale in people after venous thromboembolism (VTE) even though the benefits of testing are still subject to debate. The most important benefit would be a reduction in the risk of recurrent VTE due to the use of additional prophylactic measures. This is an update of a review first published in 2009. OBJECTIVES The objective of this review was to assess the benefit of testing for thrombophilia after VTE in terms of risk reduction of recurrent VTE. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 21 2012) and CENTRAL (2012, Issue 5). The authors searched MEDLINE and EMBASE. SELECTION CRITERIA Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared the rate of recurrent VTE in participants with VTE who were tested for thrombophilia with the rate in participants with VTE who were not tested were eligible. DATA COLLECTION AND ANALYSIS We planned to extract data from identified studies using data extraction forms. MAIN RESULTS No studies were included because no RCTs or CCTs could be identified. AUTHORS' CONCLUSIONS There are currently no randomized controlled trials or controlled clinical trials that have assessed the benefit(s) of testing for thrombophilia on the risk of recurrent VTE.
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Affiliation(s)
- Danny M Cohn
- Department of Internal Medicine, AcademicMedical Center, Amsterdam, Netherlands.
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Sechterberger MK, Hutten BA, Hermanides J, Cohn DM, Hoekstra JBL, Kamphuisen PW, DeVries JH. The incidence of diabetes mellitus following pulmonary embolism: a retrospective cohort study. J Thromb Haemost 2012; 10:2628-30. [PMID: 23082916 DOI: 10.1111/jth.12029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roshani S, Cohn DM, Stehouwer AC, Wolf H, van der Post JAM, Büller HR, Kamphuisen PW, Middeldorp S. Incidence of postpartum haemorrhage in women receiving therapeutic doses of low-molecular-weight heparin: results of a retrospective cohort study. BMJ Open 2011; 1:e000257. [PMID: 22102641 PMCID: PMC3221289 DOI: 10.1136/bmjopen-2011-000257] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Low-molecular-weight heparin (LMWH) is the drug of choice to prevent venous thrombosis in pregnancy, but the optimal dose for prevention while avoiding bleeding is unclear. This study investigated whether therapeutic doses of LMWH increase the incidence of postpartum haemorrhage (PPH) in a retrospective controlled cohort. Methods All pregnant women who received therapeutic doses of LMWH between 1995 and 2008 were identified in the Academic Medical Center, Amsterdam, The Netherlands. The controls were women registered for antenatal care in the same hospital who did not use LMWH during pregnancy, matched by random electronic selection for age, parity and delivery date to LMWH users. The incidence of PPH (blood loss >500 ml), severe PPH (blood loss >1000 ml) and median blood loss were compared in two cohorts of LMWH users and non-users. Results The incidence of PPH was 18% in LMWH users (N=95) and 22% in non-users (N=524) (RR 0.8; 95% CI 0.5 to 1.4). The incidence of severe PPH was 6% in both groups (RR 1.2; 0.5 to 2.9). The median amount of blood loss differed only in normal vaginal deliveries. It was 200 ml in LMWH users and 300 ml in non-users (difference -100 ml; 95% CI -156 to -44). Conclusion Therapeutic doses of LMWH in pregnancy were observed not to be associated with a clinically meaningful increase in the incidence of PPH or severe PPH in women delivered in this hospital, although this observation may be confounded by the differential use of strategies to prevent bleeding. A randomised controlled trial is necessary to provide a definite answer about the optimal dose of LMWH in pregnancy.
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Affiliation(s)
- Sara Roshani
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Alexander C Stehouwer
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Pieter W Kamphuisen
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Cohn DM, Goddijn M, Middeldorp S, Korevaar JC, Dawood F, Farquharson RG. Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy. J Thromb Haemost 2010; 8:2208-13. [PMID: 20704646 PMCID: PMC2965809 DOI: 10.1111/j.1538-7836.2010.04015.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although women with antiphospholipid antibodies (APLAs) are at increased risk of recurrent miscarriage, the outcome of a subsequent pregnancy is not clearly elucidated. OBJECTIVES To assess the pregnancy outcome of a subsequent pregnancy in women with APLAs and compare this outcome with women with unexplained recurrent miscarriage. METHODS We performed a cohort study among all women who attended the Miscarriage Clinic at Liverpool Women's Hospital between 1987 and 2006 after being referred due to recurrent miscarriage (≥2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for recurrent miscarriage were excluded. RESULTS A total of 693 women fulfilled the selection criteria, of whom 176 (25%) had APLAs. One hundred and twenty-two (69%) women with APLAs had a subsequent live birth compared with 324 (63%) women with unexplained recurrent miscarriage (OR 1.3, 95% CI 0.9-1.9). No differences were found for birth weight, gestational age, and intra-uterine growth restriction. When treatment was analyzed, 53/67 (79%) of women with APLAs who had received aspirin and heparin during their pregnancy had a live birth, compared with 64/104 (62%) of women with APLAs who received aspirin only (adjusted OR 2.7, 95% CI 1.3-5.8). In unexplained recurrent miscarriage, stratification for treatment showed no differences in outcome. CONCLUSION The prognosis of a subsequent pregnancy in women with APLAs is good. Although this was not a randomized clinical trial, combined treatment of aspirin and heparin seemed associated with a better outcome in women with APLAs, but not in women with unexplained recurrent miscarriage.
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Affiliation(s)
- D M Cohn
- Department of Internal Medicine, Academic Medical Center Center, University of Amsterdam, the Netherlands.
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Klok FA, Cohn DM, Middeldorp S, Scharloo M, Büller HR, van Kralingen KW, Kaptein AA, Huisman MV. Quality of life after pulmonary embolism: validation of the PEmb-QoL Questionnaire. J Thromb Haemost 2010; 8:523-32. [PMID: 20025645 DOI: 10.1111/j.1538-7836.2009.03726.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Even though quality of life (QoL) has become a key component of medical care, there is no instrument available that specifically measures QoL after pulmonary embolism (PE). Recently, the Pulmonary Embolism Quality of Life (PEmb-QoL) Questionnaire has been developed to address this gap. OBJECTIVE To evaluate the validity of the PEmb-QoL questionnaire. METHODS We distributed the PEmb-QoL questionnaire and the Short Form-36 (SF-36) questionnaire twice among consecutive subjects with a history of objectively confirmed acute PE. Internal consistency reliability, test-retest reliability, convergent validity and criterion validity, and correlations between the PEmb-QoL and clinical patient characteristics were assessed using standard-scale construction techniques. RESULTS Ninety participants completed the questionnaires twice. Internal consistency was adequate (Cronbach's alpha 0.62-0.94), as well as test-retest reliability (intra-class correlation coefficients: 0.78-0.94). Furthermore, correlation between the PEmb-QoL questionnaire and the SF-36 questionnaire supported convergent validity. Age, obesity, cardiopulmonary comorbidity, centrally located PE and a family history of venous thromboembolism were shown to be independent determinants of disease-specific QoL. CONCLUSION The PEmb-QoL questionnaire is a reliable instrument to specifically assess QoL following PE, which is helpful in the identification of patients with decreased QoL following acute PE.
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Affiliation(s)
- F A Klok
- Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.
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Abstract
BACKGROUND Factor V Leiden (FVL) increases the risk of venous thrombosis and pregnancy loss in carriers. Nevertheless, this relatively old mutation is prevalent in Caucasion populations, which could be explained by positive selection pressure. Men with FVL have previously been found to have higher fecundity (the time between marriage and first pregnancy). Whether this is caused by increased sperm counts in men with FVL is unknown. OBJECTIVES To assess whether men with factor V Leiden have increased sperm counts. PATIENTS/METHODS We performed a prospective cohort study among 1139 consecutively included male partners of subfertile couples presenting at our university hospital for fertility workup between January 2000 and July 2007. All potential candidates who gave informed consent were included, irrespective of their fertility workup. In this retrospective analysis, we excluded participants with known causes of spermatogenic function or azoospermia. Subsequently, we genotyped all participants and compared sperm counts between FVL carriers and non-carriers. RESULTS We identified 37 FVL carriers and 921 non-carriers. FVL carriers had higher total sperm counts and total motile sperm counts than non-carriers: 236 x 10(6) (95% CI 158-292 x 10(6)) vs. 163 x 10(6) (95% CI 147-178 x 10(6)) and 81 x 10(6) (95% CI 54-105 x 10(6)) vs. 52 x 10(6) (95% CI 48-57 x 10(6)), respectively. CONCLUSIONS To our knowledge, this is the first study that indicates that an increased incidence of a genotype may be controlled by increased sperm counts. However, the finding that men with FVL had higher total (motile) sperm counts was not statistically significant and needs confirmation in other studies.
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Affiliation(s)
- D M Cohn
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands.
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Cohn DM, Nelis EA, Busweiler LA, Kaptein AA, Middeldorp S. Quality of life after pulmonary embolism: the development of the PEmb-QoL questionnaire. J Thromb Haemost 2009; 7:1044-6. [PMID: 19320823 DOI: 10.1111/j.1538-7836.2009.03341.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hermanides J, Cohn DM, Devries JH, Kamphuisen PW, Huijgen R, Meijers JCM, Hoekstra JBL, Büller HR. Venous thrombosis is associated with hyperglycemia at diagnosis: a case-control study. J Thromb Haemost 2009; 7:945-9. [PMID: 19422464 DOI: 10.1111/j.1538-7836.2009.03442.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with (undiagnosed) diabetes mellitus, impaired glucose tolerance or stress-induced hyperglycemia may be at greater risk for venous thrombosis and present with relative hyperglycemia during the thrombotic event. OBJECTIVES To assess whether venous thrombosis is associated with hyperglycemia at diagnosis. PATIENTS/METHODS We performed a case-control study, derived from a cohort of consecutive patients referred for suspected deep vein thrombosis. Cases were patients with confirmed symptomatic venous thrombosis of the lower extremity. Controls were randomly selected in a 1 : 2 ratio from individuals in whom this diagnosis was excluded. We measured plasma glucose levels upon presentation to the hospital. RESULTS In total, 188 patients with thrombosis and 370 controls were studied. The glucose cut-off levels for the first to fourth quartiles were as follows: first quartile, < 5.3 mmol L(-1); second quartile, 5.3-5.7 mmol L(-1); third quartile, 5.7-6.6 mmol L(-1); and fourth quartile, >or= 6.6 mmol L(-1). When adjusted for body mass index, a known history of diabetes mellitus, age, sex, ethnicity and whether known risk factors for deep vein thrombosis were present, the odds ratios for deep vein thrombosis in the second, third and fourth quartiles of glucose levels as compared with the first quartile were 1.59 [95% confidence interval (CI) 0.89-2.85], 2.04 (95% CI 1.15-3.62) and 2.21 (95% CI 1.20-4.05), respectively; P for trend = 0.001. CONCLUSIONS Increased glucose levels measured at presentation were associated with venous thrombosis. Experimental evidence supports a potential causal role for hyperglycemia in this process. As this is the first report on the association between (stress) hyperglycemia and venous thrombosis, confirmation in other studies is required.
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Affiliation(s)
- J Hermanides
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands
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